By  Lavinia  L.  Dock 


A  Text-Book  of  Materia  Medic  a 
FOR  Nurses.  Fifth  Edition,  Revised 
and  Enlarged.     Cr.  8vo. 

Hygiene  and  Morality. 

A  Manual  for  Nurses  and  Others,  Giving 
an  Outline  of  the  Medical,  Social,  and 
Legal  Aspects  of  the  Venereal  Diseases. 


A  History  of  Nursing.  In  collabora- 
tion with  M.  A.  Nutting.  4  vols.  8vo. 
Each  fully  illustrated. 

Vols.  I.  and  II.  The  Evolution  of  the 
Methods  of  Care  for  the  Sick  from 
the  Earliest  Times  to  the  Foundation 
of  the  First  English  and  American 
Training  Schools  for  Nurses.  Two 
vols,  with  80  Ills. 

Vols.  III.  and  IV.  The  Story  of  Modem 
Nursing.  Presenting  an  Account  of 
the  Development  in  Various  Cotm- 
tries  of  the  Science  of  Trained  Nurs- 
ing with  Special  Reference  to  the 
Work  of  the  Past  Thirty  Years.  Two 
▼ols.  with  75  Ills. 

A  Short  History  of  Nursing.  A  con- 
densation of  the  four  volumes  of  the 
larger  history  of  nursing. 


Florence  JSightingale 

From  a  statuette  of  Parian  marble  now  in  the  Johns  Hopkins  Hospital  School  for  Nurses.     It  was 

modelled  by  a  sister  of  Sir  Henry  Bonham-Carter  about  i860,  and  presented  by  him  through 

Dr.  D.  C.  Oilman,  then  President  of  the  Johns  Hopkins  University,  to  the  Hospital 

after  having  been  exhibited  at  the  World's  Fair  in  Chicago,  18Q3 


A  History  of  Nursing 

The      Evolution     of     Nursing      Systems      from 

the    Earliest    Times    to     the     Foundation 

of  the   First    English   and   American 

Training  Schools  for  Nurses 

By 

M.  Adelaide  Nutting,  r.  n. 


Superintendent  of  Nurses,  The  Johns  Hopkins  Hospital ; 
I'rincipal  of  Johns  Hopkins  Training  School  for  Nurses  ; 
President  of  the  American  Federation  of  Nurses  ;  Member  of 
the  International  Council  of  Nurses  ; 

and 

Lavinia  L.  Dock,  r.  n. 

Member  of  the  Nurses*  Settlement,  New  York ;  Secretary  of  the 
American  Federation  of  Nurses  and  of  the  International 
Council  of  Nurses  ;  Honorary  Member  of  the  Matrons'  Council 
of  Great  Britain  and  Ireland,  and  of  the  German  Nurses* 
Association, 


In    Two    Volumes 

Volume  Two 


I  llus  tr  ated 


G.  P.  Putnam's  Sons 
New  York  and  London 
^be    Ikniclftetbocker    ipreas 


COPYKIGHT,   IQ07 

BY 

a.  p.  PUTNAM'S  SONS 

All  rights  reserved.     This  book,  or  parts  thereof,  must 
not   be   reproduced    in   any    form   without    permission. 


^N 


Made  in  the  United  States  of  America 


f 


CONTENTS 


NURSING 


igoi 

rHE    EIGHTEENTH 

v.l 

JT  OF  MODERN 

cz. 

CHAPTER  I 
KAISERSWERTH  AND  THE  DEACONESS  MOVEMENT 


CHAPTER  II 
PRE-NIGHTINGALE  TIMES 


62 


CHAPTER  III 
MISS  NIGHTINGALE  AND  THE  CRIMEAN  WAR 


lOI 


CHAPTER  IV 

the  nightingale  school  for  nurses  at  st. 

Thomas's  hospital  .         .         .         .172 


CHAPTER  V 

miss  nightingale's  WRITINGS 


207 


CHAPTER  VI 

MISS  nightingale's  co-workers 


287 


CHAPTER  VII 

THE  TREATY  OF  GENEVA  AND  THE  RED  CROSS 
VOL.  II.  iii 


312 


i8<i#u^ 


iv  Contents 

PAGE 

CHAPTER  VIII 

THE  DEVELOPMENT  OF  NURSING  IN  AMERICA  .       326 

CHAPTER  IX 

A  TRIO  OF  TRAINING  SCHOOLS    ....       370 

BIBLIOGRAPHY  .  .  .  ...  .       437 

INDEX    .•..•...       447 


I 


ILLUSTRATIONS 


Florence  Nightingale         .  .    Frontispiece 

The  Cradle  of  Kaiserswerth 

Friederike  Receives  Probationers 

Friederike  Fliedner    ... 

Caroline  Fliedner 

St.  John's  House 

Barrack  Hospital  at  Scutari 

Miss  Nightingale's  Night  Rounds 

Sairey  Gamp         .... 

Miss  Nightingale's  Crimean  Carriage 

A  Ward  in  the  Barrack  Hospital 

A  Ward  in  St.  Thomas's  Hospital 

Room  in  Nightingale  Home 

Ward  in  St.  Bartholomew's  in  1833 

Old  Bellevue  Hospital 

Dr.  Valentine  Seaman 

The  First  Trained  Nurse  in  America 

Sister  Helen       .... 

"The  Nurse"       .... 

A  Lesson  in  Bandaging 

Badges  of  the  Hospitals 


10 
16 
24 

30 
94 
120 
136 
152 
156 
160 
184 
206 

304 
328 
340 
352 
394 
402 
408 
434 


A  HISTORY  OF  NURSING 


CHAPTER  I 

KAISERSWERTH    AND     THE     DEACONESS    MOVE- 
I  MENT 

THE  river  Rhine  lies  broad  and  peaceful  between 
its  low,  green  banks  before  the  little  North 
German  town  of  Kaiserswerth,  and  the  majestic 
old  ruins  of  the  Kaiserpfalz  guard  the  entrance 
from  the  boat-landing  to  the  quiet  streets.  Their 
testimony  to  a  proud  and  knightly  past  is  now  ig- 
nored, and  no  one  thinks  of  Kaiserswerth  except 
as  the  home  of  the  famous  Deaconess  Mother- 
house — as  a  sort  of  shrine,  to  which  pilgrimages 
may  be  made  in  loving  and  grateful  memories 
of  the  simple,  self-forgetting  devotion  of  its 
founders.  In  this  quiet,  remote  village  beat  hearts 
whose  rhythm  started  waves  that  have  spread 
over  the  earth.  The  direct  and  indirect  exten- 
sions of  humane  endeavour  dating  from  Kaisers- 
werth may  indeed  be  likened,  according  to  the 
favourite  simile  of  the  German  pastors,  to  the  vast 
tree  beginning  as  a  tiny  acorn,  whose  branches 
cover  all  the  earth.  In  and  around  the  little 
town  itself  now  stand  eleven  noble  institutions, 

VOL.  II. —  I.  I 


2  A  History  of  Nursing 

which  have  grown  from  the  IMotherhouse.  Ex- 
tensive and  spacious  modern  buildings  fitted 
with  every  device  of  science  for  the  care  of  the 
sick  and  the  dependent  stand  in  the  beautiful 
large  gardens  of  lawn,  trees,  and  shrubbery,  so 
characteristic  of  German  institutions,  and  away 
beyond  all  of  these  is  a  fine  farm.  On  the  main 
street  of  the  village,  with  its  cobbles  and  quaint 
old-time,  two -story,  white -painted,  low- built 
houses  that  have  a  hanging  garden  in  every  win- 
dow, stands  the  Motherhouse  with  its  simple  and 
unpretending  but  extensive  front,  flanked  at  one 
end  by  the  older  building  with  its  charming 
curved  fagade.  Back  and  beyond  this  building 
through  the  luxuriant  gardens,  past  the  shady 
porches  of  the  House  of  Evening  Rest,  where  live 
the  aged  Sisters  (who  have  served  through  their 
lives  and  have  now  come  back  here  in  the  evening 
of  their  days  to  be  taken  care  of),  and  the  home 
for  superannuated  men  who  have  served  the 
establishment  and  are  now  having  their  peaceful 
days,  stands  the  Kaiserswerth  Museum,  where 
the  Sisters  have  collected  their  treasures  from  all 
corners  of  the  earth.  Here  are  a  huge,  stuffed  croco- 
dile from  the  Nile;  stone  slabs  with  Egyptian 
hieroglyphics  and  Assyrian  records;  cuneiform 
tablets,  models  of  the  Eastern  temples  and  of  the 
branch  houses  in  distant  lands;  idols  of  every 
nation;  costumes  of  every  Oriental  style;  thorns 
from  the  IMount  of  Calvary;  curious  natural  pro- 
ducts ;  the  handiwork  of  barbaric  races  and  curios 


Kaiserswerth  and  the  Deaconess       3 

innumerable.  On  a  long  table  in  the  middle  of 
the  Museum  is  a  collection  of  articles  picked  up 
by  the  nursing  deaconesses  on  many  a  field  of 
battle;  helmets,  weapons,  and  accoutrements  of 
war;  knapsacks,  flags,  and  cooking  utensils.  Then 
there  is  a  case  full  of  medals  which  have  been 
bestowed  either  on  individual  Sisters  for  bravery 
in  times  of  war  and  pestilence,  or  on  the  Mother- 
house  as  an  institution.  Again  beyond  and 
behind  the  Museum  are  more  gardens,  then  a 
roadway,  and  then,  almost  buried  in  green,  one 
comes  upon  the  tiny,  two-roomed  cottage,  the 
first  refuge  for  discharged  women  prisoners  in 
Germany — the  spot  where  Friederike  and  Theodor 
Fliedner,  in  joy  and  hope,  sheltered  the  historic 
Minna,  their  first  refugee.  This  was  the  cradle 
of  the  Kaiserswerth  institutions.  Beyond  this, 
again,  stands  an  old  tower,  once  a  mill,  now  a 
water-tower,  and  from  its  broad  base  grows  a 
row  of  little  dwellings.  Here  was  the  first  School 
for  Deaconesses,  and  here  Miss  Nightingale  and 
Agnes  Jones  lived  during  their  stay  at  Kaisers- 
werth. This  tiny  refuge ;  this  row  of  cottages  and 
the  small  shady  garden  where  '*  Mother"  Fliedner 
used  to  sit  or  walk  in  the  evening,  knitting  in 
hand,  while  she  counselled  the  different  ones  who 
came  to  her  for  advice,  form  the  heart  of  Kaisers- 
werth. ^     Here  Friederike,  creative,  a  woman  of 

»  In  1886  the  deaconesses  bought  the  Httle  garden  house, 
which  had  belonged  to  the  parish,  and  presented  it  to  the 
Motherhouse  on  its  fiftieth  anniversary. 


4  A  History  of  Nursing 

boundless  courage  and  overflowing  devotion, 
brought  into  existence  the  training  of  deaconesses. 
The  Kaiserswerth  deaconesses  now  number  nearly 
four  thousand,  and  under  their  care  are  more  than 
fifty  hospitals,  numerous  orphanages,  more  than 
forty  infant  schools,  ten  schools  for  the  higher 
education  of  girls,  with  special  schools,  such  as 
those  for  the  blind,  deaf  and  dumb,  for  manual 
work,  institutions  for  nervous  and  insane  patients, 
for  the  training  and  befriending  of  young  women 
in  domestic  service,  for  the  rescue  and  aid  of 
fallen  girls,  for  the  recuperation  of  the  Sisters, 
convalescent  homes,  and  others. 

The  branch  or  daughter  houses,  some  thirty 
in  all,  are  foimd  all  over  Germany  as  well  as  in 
man}^  foreign  countries.  Especially  interesting 
are  those  at  Jerusalem,  Alexandria,  Cairo,  Beirut, 
Smyrna,  and  Bucharest.  Not  only  its  own 
daughter  houses,  but  all  independent  institutions 
for  deaconesses  owe  their  existence  to  Kaisers- 
werth, for  all  subsequent  work  WTOught  by 
deaconesses  whether  in  France,  Switzerland,  or 
America,  whether  Lutheran,  Methodist,  or  Epis- 
copalian, has  been  the  fruit  of  the  Kaiserswerth 
tree. 

Nor  is  this  all, — the  whole  development  of 
modern  secular  nursing,  which  now  encircles  the 
ent  re  globe,  traces  its  genealogy  through  Florence 
Nightingale,  its  direct  founder,  to  Kaiserswerth 
and  its  training  school,  for  it  was  there  that  Miss 
Nightingale  went  to  study  nursing  system  and 


Kaiserswerth  and  the  Deaconess       5 

method,  when  she  was  preparing,  unconsciously, 
it  may  be,  for  her  revolutionary  reforms  in  hos- 
pital organisation. 

It  was  in  1822  that  the  young  pastor  Theodor 
Fliedner,  staff  in  hand,  set  out  on  a  journey  to 
Holland  and  England  to  beg  for  financial  rescue 
for  his  little  parish  of  Kaiserswerth,  ruined  by 
the  failure  of  a  silk  mill  at  the  very  moment  when 
he  was  installed  there  as  its  shepherd.  He  had 
been  offered  another  parish,  but  refused  it,  saying 
"  He  wished  to  be  a  true  shepherd  and  not  a 
hireling."  He  made  at  first,  however,  a  shy  and 
unsuccessful  beggar,  until  a  wise  brother  advised 
him  that  three  things  were  necessary:  ''patience, 
boldness,  and  a  fiuent  tongue."  With  renewed 
courage  he  went  on,  and  with  such  success  that 
on  his  return  he  brought  with  him  a  sum  of  money, 
the  interest  of  which  was  enough  to  support  his 
little  church  and  Sunday-school,  and  his  associa- 
tion for  young  men.  In  England  Queen  Victoria, 
then  a  little  girl,  headed  the  list  of  his  subscribers. 
But  of  far  greater  importance  than  the  money 
was  the  knowledge  gained  in  his  journey  of  what 
the  world  was  doing.  In  Holland,  deservedly 
famous  for  its  many  and  excellent  institutions 
of  charity  and  philanthropy,  some  of  which  were 
the  only  ones  that  Howard  had  found  to  com- 
mend, and  in  England,  then  thrilling  with  all  the 
impulses  which  were  later  to  flower  in  private 
and  statutory  acts  of  reform,  he  visited  numbers  of 
schools  and  educational  institutions,  almshouses. 


6  A  History  of  Nursing 

orphanages,  hospitals,  and  prisons,  and  became 
informed  of  the  methods  of  prison  societies.  "  I 
was  especially  impressed,"  he  wrote,  "with  the 
efficacy  of  the  British  Bible  and  Prison  Societies, 
and  returned  deeply  shamed  that  we  in  Germany 
had  done  so  little  for  the  prisoners."^  In  London 
he  met  Mrs.  Fry  and  saw  her  work  in  Newgate, 
with  which  he  was  deeply  impressed.  In  Holland, 
too,  to  his  great  joy,  he  had  seen  the  Mennonite 
deaconesses,  chosen  by  the  church  officers,  living 
in  their  own  homes,  but  busy  in  their  parish  work 
with  the  poor  and  the  sick.     He  wrote  of  them: 

This  praiseworthy  Christian  arrangement  ought 
to  be  introduced  into  all  other  evangelical  churches. 
The  apostolic  church  created  the  office  of  deaconess, 
knowing  well  that  the  ministrations  of  men  could 
never  form  a  substitute  for  tender  womanly  feeling 
and  fine  womanly  tact  in  solacing  physical  and  spir- 
itual distress  especially  among  other  women.  Why 
has  the  modern  Chiuch  not  retained  this  apostolic 
feature;  must  misuse  destroy  every  good  thing?  To 
how  many  women  and  maidens  would  this  not  open 
a  new  and  congenial  field?  ^ 

Fliedner  returned  to  Germany,  and,  full  of  zeal, 
founded  the  Rhenish- Westphalian  Prison  Associa- 
tion in   1826,   the  first  of  its  kind  in  Germany. 

1  Zur  Erinnerung  an  den  Besiu:h  der  Diakonissen  Anstalt  in 
Kaiser swerth.  Obtainable  at  the  Deaconess  Institute  of 
Kaiserswerth. 

^  Zur  Erinnerung,  p.  6.  Also  Theodor  Fliedner,  Ktirzer 
Abriss  Seiytes  Lebens,  Georg  Fliedner,  Kaiserswerth  Anstalt, 
1892,  p.  59. 


Kaiserswerth  and  the  Deaconess       7 

He  also,  remembering  that  Klonne  had  written  a 
paper  on  the  renewal  of  the  order  of  deaconesses 
wrote  eagerly  to  him  to  hear  his  views.  While 
he  was  thus  ardent  with  plans  and  projects,  fore- 
most among  which  in  his  mind  were  those  for 
discharged  prisoners,  whom  he  especially  yearned 
to  aid,  Friederike  Miinster,  who  was  soon  to  be 
his  wife  and  share  and  double  his  energies,  was 
engaged  in  similar  efforts  and  filled  with  ideas 
like  his  own. 

Friederike  Miinster,  destined  to  become  the 
mother  of  the  revived  apostolic  order  of  deacon- 
esses, and  the  immediate  ancestress  of  modern 
nursing,  was  born  in  the  year  1800,  just  tw^enty 
years  before  Miss  Nightingale.  Her  birthplace 
was  a  beautiful  and  romantic  spot,  the  village 
of  Braunfels  in  the  valley  of  the  Lahn,  where 
clustering  cottages,  set  in  the  most  exquisite 
frame  of  valley,  stream,  and  forest,  and  over- 
topped by  a  stately  and  many-towered  castle, 
composed  a  scene  peculiarly  German,  expressive 
at  once  of  the  most  domestic  and  the  most  ideal- 
istic traditions. 

The  spot  had  been  of  old  associated  with  a 
famous  nurse.  Six  hundred  years  earlier  Eliza- 
beth, the  beloved  mother  of  the  poor,  had,  in 
pursuance  of  a  vow,  travelled  barefoot  to  bring 
her  little  daughter  to  the  old  cloister  of  Altenberg 
(now  no  longer  in  existence)   near  by. 

Fried erike's  early  life  was  a  round  of  those  house- 
hold and  family  duties  which  are  so  perfect  a 


8  A  History  of  Nursing 

preparation  for  nursing.  Her  father  had  been 
a  schoolmaster;  later  Comptroller  on  the  estate 
of  Prince  Solms  Braimfels.  As  a  young  girl,  she 
had  been  acquainted  with  poverty  and  struggle, 
but  also  with  a  life  of  active  hospitality  and 
intimate  association  with  many  kinds  of  people, — 
from  those  of  the  court  circles,  down  to  the  low- 
liest. The  joy  of  usefulness  irradiated  Frieder- 
ike's  days,  and  when,  in  her  twenty-fifth  year, 
the  little  brothers  and  sisters  having  grown  to 
self-support  and  her  father  having  married  a 
second  time  she  was  no  longer  needed  in  the  home, 
she  offered  her  voluntary  services  to  Count  Von 
der  Recke,  who  had  founded  an  institute  in 
Diisselthal  near  Diisseldorf  for  the  rescue  of 
children.  What  her  spirit  was  in  her  service  here 
can  be  read  in  the  prayer  which  she  inscribed  in 
her  diary;  Du  hist  die  Liebe,  lass  mich  Liehe 
werden  I  Two  years  of  this  work  brought  her 
a  severe  illness,  and  whilst  recuperating  from  it 
in  the  home  of  a  friend,  she  was  introduced  to 
pastor  Fliedner,  who  was  then  seeking  for  some 
one  to  befriend  the  female  convicts  in  the  prison 
at  Diisseldorf.  Friederike  had  been  recommended 
to  him  for  her  gifts  of  mind  and  heart,  and  she 
would  have  devoted  herself  gladly  to  the  prison 
work,  had  not  her  parents  been  unwilling.  But 
when  Fliedner  soon  after  asked  her  in  marriage 
they  consented,  and  Friederike  thenceforth  had 
not  only  the  convicts,  but  the  whole  parish  as 
well  on  which  to  lavish  her  energies.    From  first  to 


Kaiserswerth  and  the  Deaconess       9 

last  she  sympathised  actively  with  her  husband 
in  the  prison  mission  work.  Her  first  individual 
effort  was  to  start  a  woman's  society  for  nursing 
and  visiting  in  the  homes  of  the  poor,  of  whom 
there  were  many,  in  the  little  parish,  and  she 
was  herself  untiring  in  visiting,  cooking  for  the 
sick,  nursing  and  cheering  them,  as  Elizabeth 
of  Hungary  had  been  before  her.  ''in  thy 
mother's  dealings  with  the  poor  I  learned  what 
the  Scripture  means  when  it  says,  'Let  the  poor 
find  thy  heart,'  "  said  Fliedner^  in  later  life  to  his 
daughter.  She  had  a  special  gift  of  drawing  souls  to 
her.  Her  influence  was  oftenest  a  silent  one,  but  at 
the  right  moment,  she  knew  the  right  word  to  say. 
Her  next  work  was  to  establish  knitting  lessons 
for  the  girls.  They  met  in  the  tiny  garden  house 
under  the  direction  of  Fraulein  Frickenhaus  and 
this  nucleus  later  developed  into  the  school  for 
little  children. 2  Paster  Fliedner  was  continually 
obliged  to  travel  from  home  to  collect  money  and 
stimulate  interest  in  the  work  of  the  Prison  Asso- 
ciation, and  during  his  many  absences  Friederike 
managed  the  parish  and  carried  on  every  under- 
taking. It  was  soon  borne  in  upon  them  both 
that  it  was  useless  to  think  of  helping  the  prisoners 
unless  there  was  some  place  to  receive  them  upon 
discharge,  and  Friederike  urged  her  husband  to 
open  a  refuge  for  them. 

ijahrbuch    fur    Christliche     Unterhaltung,      Kaiserswerth, 
1894,  p.  10. 
2  Ibid. 


lo  A  History  of  Nursing 

My  parish  [wrote  Fliedner]  the  smallest  in  the  coun- 
try about,  seemed  least  fitted  for  such  an  attempt.  But 
none  of  the  clergy  of  the  neighbouring  parishes  would 
undertake  it.  My  wife  insisted  that  we  should  make 
the  beginning  and  I  gladly  agreed  to  it.  It  was  still 
more  difficult  to  find  the  right  woman  to  place  in 
charge, — some  one  wise,  kind,  and  patient  enough. 
But  my  wife  succeeded,  by  urgent  letters,  in  inducing 
an  old  and  dear  friend,  Katherine  Gobel  of  Braunfels, 
to  come  to  us  to  talk  it  over.  Her  relations  were 
opposed  to  it.  She  herself  fell  ill,  and  her  courage 
wavered,  when  unexpectedly  on  the  17th  of  September, 
1833,  a  young  convict,  Minna  by  name,  just  dis- 
charged from  the  penitentiary,  came  in  and  begged 
piteously  to  stay.  We  could  not  refuse,  but  where 
to  put  her?  In  the  garden  stood  a  tiny  house,  the  fa- 
vourite resort  of  the  children,  and  we  domiciled  Minna 
there.  The  little  house  was  only  twelve  feet  square, 
and  no  stairway  led  to  its  tiny  garret,  so  Minna 
ascended  from  the  outside  on  a  ladder  to  go  to  bed, 
and  the  next  morning  climbed  down  the  same  way. 

This  was  the  seed  that  grew  into  the  great  tree. 
From  this  little  garden  house  all  the  institutions 
of  Kaiserswerth  were  one  by  one  developed. 
Fraulein  Gobel  remained;  ("  Minna  did  her  more 
good  than  iron  and  quinine,"  wrote  Fliedner)  but 
Frau  Fliedner  bore  the  brunt  of  the  care  and  re- 
sponsibility of  the  Refuge  for  the  first  few  years 
of  its  growth,  until  it  became  a  large  and  firmly 
established  asylum. 

The  care  of  the  sick  and  how^  to  make  pro- 
vision for  it  w^as  the  next  engrossing  thought  of 


J-2  - 


Kaiserswerth  and  the  Deaconess     1 1 

Friederike's  mother  heart.  ^     FHedner  shared   it 
to  the  full. 

The  thought  of  the  sick  poor  had  long  lain  heavy 
on  our  hearts  [he  wrote].  How  often  had  I  seen  them, 
forsaken;  their  bodily  needs  neglected,  and  their 
souls  quite  forgotten,  fading  in  their  dull  unhealthy 
cabins  like  leaves  in  autumn;  and  how  many  cities, 
even  large  ones,  were  without  hospitals;  and  even 
where  there  were  hospitals, — I  had  seen  many  on  my 
travels  through  Belgium,  Holland,  England,  and 
Scotland  and  in  our  own  Germany — often  with 
marble-trimmed  exteriors,  but  the  nursing  was 
wretched.  Physicians  complained  bitterly  of  the 
hireling  service  by  day  and  night,  of  the  drunkenness 
and  immorality  of  the  attendants.  And  what  is  to 
be  said  of  the  spiritual  care?  Little  thought  is  given 
to  it.  In  many  hospitals  pastors  are  unknown  and 
chapels  not  thought  of.  Would  not  our  young  Chris- 
tian women  be  able  and  willing  to  do  Christian 
nursing?  Had  not  many  such  women  performed 
wonders  of  self-sacrificing  love  in  the  lazarettos  and 
military  hospitals  of  the  War  of  Freedom?  The 
apostolic  Church  had  utilised  this  force  for  the  benefit 
of  the  downtrodden,  and  through  hundreds  of  years 
had  appointed  women  to  the  diaconate.  Ought 
we  to  delay  in  bringing  back  consecrated  women 
into  the  service  of  the  Lord?  Such  thoughts  gave 
me  no  rest.  My  wife,  also,  was  of  like  mind,  and  of 
far  greater  courage  than  myself.  But  was  this  little 
Kaiserswerth,  with  its  preponderating  Catholic  popu- 
lation; where  there  were  not  enough  sick  people  to 

»  Das  Diakonissen  Mutterhaus,  und  seine  Tochterhduser, 
Julius  Disselhoff,  Kaiserswerth,  1893,  p.  7. 


12  A  History  of  Nursing 

provide  a  school  for  instruction;  where  the  general 
poverty  could  promise  no  financial  aid — could  this 
be  the  right  place  for  a  school  for  evangelical  nurses? 
Were  there  not  more  experienced  pastors  than  I, 
better  fitted  for  so  difficult  an  undertaking?  I  went 
to  my  colleagues  in  Dusseldorf,  Elberfeld,  Barmen, 
etc.,  and  urged  them  to  consider  whether  one  of 
them  might  not  undertake  what  must  be  almost 
necessar}'  in  their  large  parishes.  Every  one  declined 
my  proposition.  "I  was  the  right  one  to  try  it;  my 
little  parish  gave  me  enough  time  for  it:  the  quiet 
seclusion  of  Kaiserswerth  would  be  favourable  to 
such  an  undertaking.  Beside,  the  Lord  did  not 
intend  all  my  travel  experiences  for  nothing.  He 
was  able  to  send  mone}"  to  Kaiserswerth  and  patients 
and  nurses  as  well.'"  ^ 

Thus  the  arguments — no  one  pointed  out  the 
fact,  that  no  other  but  Fliedner  knew  of  a  woman 
who  could  begin  such  a  work  and  build  it  up  to 
completion,  but  this  was  the  truth.  This  was 
pre-eminently  a  work  that  needed  the  direction  of 
a  gifted  woman,  and  pastor  Fliedner  came  home 
to  his  wife. 

We  saw  at  last  [he  says]  that  it  was  the  Lord's 
purpose  to  lay  this  task  upon  our  shoulders.  We 
assumed  it  gladly.  We  looked  about  quietly  for  a 
house  to  use  as  a  hospital.  One  day  the  largest  and 
best  house  in  Kaiserswerth  was  offered  for  sale.  My 
wife  had  been  confined  only  three  days  before; 
nevertheless,  she  persuaded  me  to  buy  the  house  in 
the  name  of  the  Lord.  The  price  was  2300  thalers 
^Kurzer  Abriss,  etc.,  pp.  59-61. 


Kaiserswerth  and  the  Deaconess     13 

and  we  had  no  money.  I  bought  it  in  faith  on  the 
20th  of  April,  1836.  The  money  was  to  be  paid  at 
Christmas. 

When  the  time  came  to  pay  the  money,  it  was  all 
in  his  hands :  an  experience  that  was  often  repeated 
in  later  years.  ^ 

The  hospital  was  not  fitted  up  without  opposi- 
tion. The  neighbours  objected  to  it,  and  there 
was  clerical  enmity.  Fhedner  was  threatened 
that  the  village  authorities  would  complain  of 
him  to  the  government,  and  the  physicians 
who  had  been  engaged  to  attend  the  patients 
thought  it  dangerous  for  Fliedner  to  go  off  at  that 
moment  on  a  money-collecting  tour,  as  the  general 
excitement  might  bring  some  danger  to  his  wife. 
''But  she  laughed  at  this,"  writes  Fliedner,  "and 
sent  me  gaily  on  my  journey,  for  she  relied  on  a 
higher  power."  Finally,  on  the  i6th  of  October 
the  first  patient  came  (a  Catholic  maidservant)  and 
on  the  20th  the  first  deaconess  arrived. 

Who  was  happier  than  our  dear  mother?  Fifty 
times  a  day  she  ran  back  and  forth  between  the 
parsonage  and  the  hospital,  advising,  providing, 
carrying  furniture,  making  beds  and  arranging  the 
rooms,  speaking  a  cheerful  word  to  the  patient  and 
directing  the  helpers,  until  the  inmates  of  the  asylum 
grew  jealous,  lest  in  the  absorption  of  the  new  work 
the  old  would  be  forgotten.     But  this  did  not  happen. 2 

The  furniture  had  all  been  donated  and  was  of 

1  Zur  Erinnerung,  p.  7. 
^  Jahrbuch,  p.  14. 


14  A  History  of  Nursing 

the  humblest  description.  A  shabby  table,  some 
broken-backed  chairs,  worn-out  knives,  two- 
pronged  forks,  worm-eaten  beds,  and  appliances 
to  match  had  been  sent  in. 

We  moved  in  with  a  mean  outfit,  but  with  boundless 
joy  and  thanksgiving.  So  the  small  and  insignificant 
seed  of  the  deaconess  institute  was  planted  with 
faith  in  the  way  of  the  Apostolic  Church,  and  it  has 
had  a  rich  growth. 

By  the  end  of  the  month  there  were  four  patients 
in  the  house. 

We  may  here  draw  attention  to  a  somewhat 
prevalent  popular  error  regarding  the  first  dea- 
conesses, namely,  that  pastor  Fliedner  utilised  the 
young  women  prisoners  to  establish  the  nursing 
work,  and  that  the  first  members  of  the  Sisterhood 
were  therefore  repentant  sinners  who  had  taken 
refuge  in  the  asylum.  ^ 

This  is  an  entire  mistake.  The  deaconesses 
were  never  drawn  from  the  class  of  prisoners, 
but  were  always  carefully  chosen  from  applicants 
of  blameless  lives.  The  prisoners'  refuge  was 
simply  one  of  the  many  branches  of  loving  service 
conducted  by  the  Fliedners. 

Gertrude  Reichardt,  the  first  Kaiserswerth 
deaconess,  was  the  daughter  and  the  sister  of  a 
physician.     She  was  born  in  Ruhrort  in  1788  and 

»  A  magazine  article,  which  the  writers  have  not  been  able 
to  identify,  but  which  seems  to  have  been  rather  widely  read, 
has  evidently  propagated  this  error. 


Kaiserswerth  and  the  Deaconess     15 

was  already  a  woman  of  mature  years  and  of 
much  practical  experience  as  a  nurse.  In  her 
father's  home  she  had  been  accustomed  to  assist 
him  with  dressings  and  operations,  and  during  the 
War  of  Freedom  she  had  been  his  constant  helper. 
When  her  brother  became  a  physician  she  had 
gained  further  large  experience  in  the  care  of  the 
sick  among  his  patients.  She  was  admirably  fitted 
for  the  work  of  the  new  hospital,  and  the  Fliedners 
had  long  known  of  her  and  for  a  time  had  tried 
in  vain  to  persuade  her  to  take  up  the  new  and 
experimental  post  of  deaconess.  Finally,  in  the 
early  autumn  they  had  induced  her  to  come  and 
see  the  new  hospital.  It  looked  very  bare  and 
poor  and  she  could  not  decide  to  remain;  was,  in 
fact,  about  to  return  home  when  a  large  bundle 
was  brought  in  by  post,  which  contained  a  quan- 
tity of  new  bed-linen,  clothing,  and  ward  fittings. 
This  simple  occurrence  was  regarded  by  her  as  a 
providential  sign,  and  she  promised  to  come  in 
October.  Two  young  women  promised  to  come 
and  assist,  though  not  willing  to  become  deacon- 
esses. Gertrude  remained  in  the  service  until 
1855  when  she  withdrew  to  the  House  of  Evening 
Rest  {Feierabend  Haus)  for  the  old  Sisters  at  the 
age  of  sixty-eight  years.  Her  experience,  devo- 
tion, and  character  made  her  an  ideal  pioneer  and 
a  most  valuable  aid  to  Frau  Fliedner  in  the  work 
of  training  the  new  Sisters.  ^     Friederike,   how- 

*  Gertrude's  life  was  sketched   in  a  Church  Journal,   Ar- 
men  und  Krankenfreund,  published  at  Kaiserswerth  in  1869. 


i6  A  History  of  Nursing 

ever,  remained  the  head  and  centre  of  the  hospital 

work.     Pastor  Fliedner  writes: 

The  first  deaconess,  whom  we  had  intended  to 
make  the  superintendent,  and  who  was  a  complete 
mistress  of  the  arts  of  caring  for  both  body  and  soul 
of  her  patients,  nevertheless  had  not  the  rarer  but 
most  essential  talents  of  ruling  and  of  administration. 
Consequently  it  was  necessary  for  my  wife  to  assume 
the  position  of  superintendent,  and  the  unselfish 
Sister  yielded  the  ruling  power  with  true  Christian 
self-abnegation.^ 

In  this  first  year  six  other  deaconesses  wer^ 
received, — Beata,  Johanna,  Helena,  Franziska, 
Catherina,  and  Carolina.  Sixty  patients  in  all 
were  cared  for  in  the  hospital  and  twenty-eight 
in  their  own  homes.  The  visited  cases  were  all 
among  the  poor,  and  most  of  them  w^ere  furnished 
with  diets  from  the  Motherhouse.  The  work  was 
divided  up  in  this  way:  one  deaconess  did  the 
cooking  and  housekeeping,  another  had  the  laim- 
dry  and  linen  department,  one  the  women's  ward, 
one  the  men's,  with  the  aid  of  an  orderly,  and  an- 
other the  children's.  They  changed  about  syste- 
matically and  in  summer  time  one  was  kept  busy 
in  the  garden.  Theoretical  and  clinical  instruc- 
tion was  given  by  Dr.  Thonissen,  who  used,  as  a 
basis,  Dr.  Dieffenbach's  manual.  The  deaconesses 
also  studied  pharmacy  and  passed  the  state  exam- 
ination on  this  subject.     At  Christmas  time  Flied- 

ijahrbuch,  p.  14. 


o  £    ^ 


>     (U     ^r 

Ji  "^    ^ 


5< 

O 

.is 


^ 


I 


Kaiserswerth  and  the  Deaconess     17 

ner  invited  Amalie  Sieveking  to  take  charge  of  the 
new  work,  in  order  to  release  his  wife  to  her  family 
cares,  but  she  was  unable  to  leave  her  work  in 
Hamburg  and  Friederike  continued  as  the  head  of 
the  establishment.  The  annual  report  of  that 
period  speaks  of  her  as  follows:  "The  office  of 
Matron  (Mother,  Superintendent)  has  been  filled 
by  the  wife  of  the  writer,  who  will  continue  until  a 
suitable  head  has  been  trained."  But  this  time 
did  not  come;  for,  though  suitable  ones  w^ere 
trained,  they  were  urgently  demanded  in  new 
fields,  and  Friederike  kept  her  post  as  House 
Mother  until  her  too  early  death.  Wacker,  judg- 
ing, from  the  man's  standpoint,  the  wife  as  an 
auxiliary,  wrote: 

Her  keen  glance  and  pure  and  holy  spirit  kept  him 
(Fliedner)  from  making  mistakes.  With  the  virtues 
of  cleanliness,  order,  simplicity,  and  economy  she  had 
a  large-hearted  compassion,  great  energy,  and  strong 
rational  sense  to  prevent  the  misdirection  of  minister- 
ing love.  She  became  a  model  to  the  deaconesses  as 
well  as  a  mother  to  them.  Her  name  deserves  men- 
tion as  one  who  took  an  important  part  in  the  work.^ 

Thus  placed  in  charge  of  an  untried  undertaking, 
the  pastor's  wife  reflected  often  and  earnestly  upon 
the  duties  and  responsibilities  belonging  to  it — of 
how  best  to  choose  the  Sisters ;  to  train  them  and 
place  them  in  new  positions;  of   their  relations 

^  Der  Diakonissen  Beruf,  Emil  Wacker  (Giitersloh,  1888),  p. 
116. 

VOL.   II. 2. 


i8  A  Histon/  of  Nursing 

to  one  another  and  to  their  directors.  She  re- 
corded her  reflections  and  conclusions  in  a  small 
volume,  which  was  long  the  guide  for  those  en- 
gaged in  the  training  of  deaconesses,  and  in  all  the 
essentials  still  remains  the  accepted  standard  of 
Kaiserswerth.  What  a  pity  that  this  volume,  the 
first  work  on  the  training  of  nurses  to  be  written 
by  a  woman,  the  fruit  of  her  practical  experience 
and  thought,  fired  by  enthusiasm  and  directed  by 
a  most  able  mind,  should  not  have  been  given  to 
the  public.  It  would  be  indeed  a  classic.  But  we 
may  judge  of  its  contents  by  the  statement  of  prin- 
ciples later  presented  by  Schafer.  The  key-note 
of  Friederike's  teaching  was  a  sentence  inscribed 
m  the  title-page  of  her  note-book,  "  Niemand  gehe 
die  Seek  pre  is  am  der  Kunst  willen''  which  we 
may  transcribe  thus:  Never  sacrifice  the  soul  of 
the  work  for  its  technique.  Truly,  if  every  wo- 
man made  this  tone  her  own,  no  other  ethical 
teaching  would  be  needed. 

While  Friederike  was  supreme  at  home,  pastor 
Fliedner  vvas  untiring  in  his  exertions  abroad,  trav- 
elling, speaking,  rousing  interest  in  the  work,  and 
founding  new  branches.  The  work  grew  heavier, 
and  Friederike's  letters  often  spoke  of  an  almost 
crushing  mass  of  duties  and  demands  upon  her 
strength.  Not  the  least  of  these  demands  came 
from  the  many  visitors,  for  now  the  fame  of 
Kaiserswerth  was  bringing  humanitarians  and  phil- 
anthropists from  far  and  near  to  inspect  the  dea- 
conesses' institute.     One  of  the  most  welcome  was 


I       Kaiserswerth  and  the  Deaconess     19 

Mrs.  Fry,  who  had  so  strongly  influenced  Fliedner 
in  his  younger  days.  She  came  in  May,  1840,  and 
although  she  spoke  little  German,  and  Friederike 
no  English,  these  two  enthusiasts  felt  little  need  of 
words,  for  they  were  at  once  conscious  of  an  inner 
bond  which  made  of  looks  and  gestures  a  sufficient 
language.  Elizabeth  Fry's  approbation  of  all  she 
saw  at  Kaiserswerth  rejoiced  Friederike's  heart 
and  gave  her  fresh  courage,  while  abroad  it  did 
much  to  win  new  friends  for  the  cause  and  allay 
prejudice.  An  incident  of  this  day  which  is  told 
by  Friederike's  biographer  is  strikingly  illustra- 
tive of  her  fortitude.  Just  before  Mrs.  Fry's  ar- 
rival she  had  a  letter  telling  her  of  the  death  of 
pastor  Fliedner 's  brother ;  but,  unwilling  to  agitate 
her  husband  at  the  moment  of  this  eagerly  ex- 
pected visit,  she  kept  the  sad  news  to  herself  with 
tranquil  mien  until  the  guest  had  left. 

When  it  is  remembered  that,  in  addition  to  her 
many  duties,  Friederike  was  the  mother  of  a  group 
of  children  (she  bore  nine  in  all,  but  four  died  at 
birth) ,  it  is  not  surprising  that  sometimes  even  her 
spirit  sank  under  its  burden.     Wrote  Fliedner : 

The  rearing  of  her  children  brought  the  tender 
mother  much  joy,  and  also  much  anxiety.  Some 
of  the  children  were  delicate,  and  she  could  not  devote 
herself  to  them  as  she  wished.  The  cares  of  the  many 
poor  of  our  parish,  her  share  of  interest  in  the  asylum 
for  prisoners,  in  the  children's  school  and  the  school 
for  teachers  now  connected  with  it,  the  post  of  super- 
intendent in  the  young  but  yearly  growing  training- 


20  A  History  of  Nursing 

school  for  deaconesses, — were  no  light  burdens  for 
her  to  carry.  Add  to  this  the  numerous  visitors, 
who  came  almost  daily,  and  who  usually  stayed  to 
meals.  No  wonder  that,  strong  as  were  her  shoul- 
ders and  great  the  courage,  the  administrative  talent, 
the  practical  knowledge  and  the  skill  with  which  the 
Lord  had  endowed  her,  she  sometimes  groaned  under 
the  burden  and  asked  if  there  was  not  a  conflict  be- 
tween her  duties  as  mother  and  as  head  of  the  insti- 
tution, and  if  there  was  not  some  way  to  reconcile 
them.  We  talked  it  over  from  every  side  to  see  if  it 
were  not  possible  to  substitute  for  her  in  the  work, 
but  we  could  find  no  way.  Then  she  could  not  but 
realise  how  especially  blessed  her  leadership  in  the 
work  had  been.  In  the  daily,  almost  hourly,  neces- 
sary directions  and  advice,  the  spiritual  charge  of  so 
many  individuals  and  their  training,  who  could  be 
so  strong  a  support  to  the  work  as  she?  Moreover, 
my  wife  felt  that  the  care  of  the  children  was  not 
only  in  our  hands  but  in  the  hands  of  God.  She  had 
also  before  her  the  reassuring  example  of  Countess 
Zinzendorf ,  whose  ability  to  lead  a  life  crowded  with 
public  duties,  similar  to  her  own,  and  yet  to  be  an 
excellent  mother  to  her  children,  she  had  always  ad- 
mired. The  development  of  the  deaconess  training 
was  new  to  our  church,  and  in  all  the  rules,  in  their 
dress,  in  their  discipline,  there  was  so  careful  a  line 
to  be  drawn  between  the  extreme  sacrifice  of  freedom 
of  the  cloister  and  the  avoidance  of  a  demoralising 
liberty,  that  the  keen,  womanly  and  holy  perception 
of  my  wife  was  indispensable  in  avoiding  mistakes. 
The  homely  virtues  of  cleanliness,  order,  simplicity, 
and  economy,  with  boundless  kindness  for  all  sufferers, 


Kaiserswerth  and  the  Deaconess     21 

so  important  for  the  Sisters  in  their  works  of  mercy, 
who  else  but  my  wife  could  teach  and  enforce 
them  rightly?  Then  the  masculine  energy  which 
she  possessed  and  the  way  in  which  she  could  control 
and  subdue  wrongdoers  and  prevent  imposition — this 
united  with  her  native  gentleness  made  an  extraor- 
dinary combination  of  character.^ 

So,  for  the  sake  of  the  work,  Friederike  con- 
tinued to  bear  the  double  burden.  The  years  1841 
and  1842  were  full  of  family  affliction.  Her  hus- 
band and  three  of  her  children  were  prostrated  by 
severe  illness,  and  as  they  slowly  passed  the  danger 
line  the  time  came  when  an  engagement  previously 
made  to  organise  the  nursing  work  in  two  other 
German  cities  had  to  be  met.  Fliedner,  almost 
convalescent,  was  entirely  unfit  to  go.  The  cir- 
cumstances were  urgent,  for  the  need  was  very 
great,  and  Friederike,  faithful  to  her  responsibil- 
ities as  head  of  a  nursing  order,  put  her  younger 
sister  in  charge  of  her  sick  children  and  prepared 
for  the  journey. 

"What  it  must  have  cost  her  to  tear  herself 
away  from  her  loved  ones  only  the  heart  of  a 
mother  can  know!"  She  took  with  her  four 
deaconesses  to  begin  the  new  work.  The  condi- 
tions she  found  were  horrible;  they  were  the 
conditions  generally  prevalent  in  hospitals  at 
that  time,  and  give  a  realising  sense  of  the  Augean 
stables  which  were  cleaned  by  the  labours  of  the 

»  Kurzer  Abriss,  pp.  75-76.     Jahrbuch,  pp.  18-19. 


22  A  History  of  Nursing 

faithful    deaconesses.     Friederike    wrote    to    her 
husband : 

At  nine  o'clock  the  director  and  secretary  ac- 
companied us  to  the  hospital.  I  was  often  so  nause- 
ated at  what  I  saw  I  had  to  run  to  the  window  — 
the  filth  and  vermin  were  indescribable.  The  haunts 
of  thieves  could  be  no  worse.  A  woman  has  been 
here  since  1838  who  is  not  yet  cleansed  from  vermin. 
The  doctors  make  rounds  certainly  not  too  often. 
They  were  here  yesterday.  A  drunkard  who  had 
tried  to  cut  his  throat  was  proposed  to  me  by  the 
committee  as  an  attendant  for  the  sick — I  declined. 

The  inventory  is  to  be  given  us  to-day.  Most  of 
the  bedding  will  have  to  be  dragged  with  prongs 
and  tongs  to  the  stable.  We  will  do  this  on  Monday. 
To-day  the  Sisters  with  a  scrub-woman  are  cleaning 
the  room  into  which  we  will  move  to-morrow  evening, 
Sunday.  I  would  like  to  stay  here  several  days  to 
relieve  the  dreariness  for  the  Sisters,  get  the  male  at- 
tendant grounded  in  his  work  and  have  some  rooms 
cleaned.  The  whole  committee  is  coming  to  the 
hospital  to-day  at  four  o'clock,  and  I  must  meet  them. 

I  have  told  the  directors  that  if  conditions  are 
not  altered  we  will  not  allow  the  Sisters  to  stay  .  .  . 
for  they  shall  not  kill  themselves  working  for  nothing 
.  .  .  and  in  such  dens  of  immorality  they  could 
accomplish  nothing. 

I  wish  I  could  write  a  description  of  the  glorious 
mountains  for  my  beloved  children,  but  I  must  hurry. 
I  have  much  to  do  and  little  time  to  write.  God 
bless  you  and  the  dear  loyal  Sisters  without  whom 
we  could  do  nothing  of  all  this.  Oh,  my  beloved 
Hannah   [the   youngest   of   the   sick   children],  how 


Kaiserswerth  and  the  Deaconess     23 

fain  would  I  be  with  thee,  dearest  Hfe — it  cannot  be — 
I  must  renounce  much — the  Lord  give  me  a  wilHng 
heart — Ever  thy  Friederike.^ 

Friederike  returned  home  to  find  that  one  of  the 
children  had  had  a  relapse  and  was  gone  from  her, 
and  a  few  days  later  the  little  Hannah  also  died. 
This  double  loss  inspired  the  mother  to  her  last 
work,  the  founding  of  an  asylum  for  orphans. 
She  had  often  thought  of  it,  and  now  one  day  she 
brought  in  two  motherless  children  and  made 
them  at  home  with  her  own  remaining  little  ones. 
From  this  beginning  grew  the  many  orphanages 
of  Kaiserswerth. 

Friederike  was  now  at  the  end  of  her  labours; 
she  could  bear  and  do  no  more,  and  on  the  22nd  of 
April,  1842,  after  a  few  days'  illness,  she  gave  pre- 
mature birth  to  a  dead  infant,  and  breathed  her 
last.2 

She  died  the  first  [wrote  Fliedner]  of  all  the  deacon- 
esses: as  she,  the  Mother,  was  in  all  things  the  leader 
among  her  spiritual  daughters,  so  she  went  before 
them  in  death.  How  this  great  void  is  to  be  filled 
is  known  only  to  God. 

The  historical  disappearance  of  Friederike  and 
the  complete  identification  of  pastor  Fliedner 
with  all  of  her  creative  and  executive  work  is  a 
characteristic  example  of  the  way  in  which  the 
woman's   share   of   the    world's   work   has   been 

» Jahrbuch,  pp.  21-22. 
» Ibid.,  p.  24. 


24  A  History  of  Nursing 

generally  ignored.  Numerous  and  copious  are  the 
books,  pamphlets,  essa3^s,  and  magazine  articles 
on  the  Kaiserswerth  revival  of  the  deaconess 
order;  yet  rarely  is  Friederike  even  alluded  to. 
All  is  attributed  to  her  husband,  even  those  details 
of  the  actual  nursing  organisation  and  training 
which  he  himself  has  expressly  stated  were  her 
own.  Pastor  Fliedner  is  to  be  exonerated  from 
any  share  in  this  historical  injustice.  His  own 
part  in  the  work  was  sufficiently  important,  with- 
out taking  hers,  and  in  describing  their  purposes 
and  efforts  he  always  said  "we."  It  has  come 
about  from  the  "unconscious  vanity  of  subsequent 
pastors  who  undertook  in  their  turn  similar 
organisation,  that  the  composite  picture  called 
Fliedner  has  been  drawn,  and  copied  thoughtlessly 
by  scribes  of  all  nations.^ 

For  a  year  they  groped  on  alone ;  the  Sisters  did 
their  best  to  share  the  burden  laid  down  by  Frie- 
derike.    To  make  administration  easier,  Fliedner 

1  The  rediscovery  of  Friederike  was  due  to  the  intuition 
of  Mrs.  Bedford  Fenwick,  an  English  nurse  and  writer,  who 
first  set  on  foot  the  inquiries  which  brought  her  real  share  in 
the  deaconess  movement  to  light.  At  the  Berlin  meeting 
of  the  International  Council  of  Women  in  1904,  Mrs.  Fenwick 
stated  Friederike 's  eminence,  which  had  been  forgotten  even 
in  German}^  and  she  first  gave  an  English  translation  of  her 
life  in  the  British  Journal  of  Xursing,  May  26,  1906,  et  seq., 
called  "Friederike  Fliedner,  the  first  Superintendent  of  the 
Deaconess  Institution  at  Kaiserswerth,"  translated  by  Miss 
L.  Metta  Saunders:  taken  from  Pastorin  Friederike  Fliednei : 
die  erste  Vorsteherin  der  Diakonissen  Anstali.  Arnien-und- 
Krankenfreund,   1871. 


Friederike  Fliedner 

From  JaJirbuch  fiir  Christliche   Unterhaltun^,   Kaisers- 

werth,  1S94 


Kaiserswerth  and  the  Deaconess     25 

formed  a  conference  of  all  the  older  Sisters,  at 
which  they  took  counsel  together  as  to  the  conduct 
of  the  establishment.  Even  although  the  main- 
stay was  gone,  the  work  had  to  go  on.  The  King 
of  Prussia,  Frederick  William  IV.,  was  planning 
a  deaconess  house  for  Berlin,  which  Fliedner  was 
to  start.  Again  he  went  to  Hamburg  to  see 
Amalie  Sieveking,  and,  as  has  been  already  told, 
through  her  he  met  her  fnend  Caroline  Bertheau, 
who  was  in  charge  of  the  nursing  department 
in  the  general  hospital.  A  second  time  in  seeking 
a  superintendent  for  his  work  Fliedner  found  a 
wife,  and  again  one  as  capable,  as  devoted,  and 
as  self-forgetting  as  the  first.  Caroline  married 
him,  took  charge  of  his  household  and  motherless 
children  together  with  the  whole  large  and  rapidly 
growing  deaconess  establishment,  and  brought 
up  eight  children  of  her  own  as  well.  She  sur- 
vived him  long,  for  pastor  FHedner  died  in  October, 
1864,  after  strenuous  and  increasing  labours,  but 
Frau  FHedner,  truly  "Mother"  Fliedner,  re- 
mained for  almost  twenty  years  after  this  the 
head  and  heart  of  the  whole  work,  assisted  ably 
by  her  son-in-law,  Dr.  Disselhoff . 

On  their  wedding  trip  pastor  FHedner  took 
her  to  Berlin,  where  the  Kaiserswerth  Sisters  had 
just  been  placed  in  charge  of  the  venereal  wards 
of  the  Charite.  The  work  was  new  to  them  and 
had  come  about  as  the  result  of  a  report  w^hich 
Fliedner  had  made  to  the  Princess  Marianne  and 
the  Queen,  of  the  horrible  abuses  then  prevalent 


26  A  History  of  Nursing 

in  every  department  of  the  old  city  hospital. 
Pastor  Fliedner  was  very  anxious  about  this  pio- 
neer reform,  and  Caroline,  having  had  experience 
in  a  similar  service  in  Hamburg,  went  straight 
into  the  wards  with  the  Sisters  and  worked  with 
them  until  their  ^vay  was  smoothed  out  before 
them. 

Let  us  pause  here  for  a  glance  at  the  old  hos- 
pital, the  scene  of  Caroline's  honeymoon. 

One  of  the  famous  hospitals  of  the  world,  though 
not  so  ancient  as  many  others,  is  the  Charite  of 
Berlin,  long  a  noted  centre  for  medical  teaching. 
It  has  also  had  an  interesting  and  instructive 
(though  not  admirable)  nursing  history,  and  is 
distinguished  as  one  of  the  hospitals  where  nursing 
reforms  in  modern  times  were  first  attempted. 
If  it  cannot  be  said  that  these  were  successful 
at  least  the  credit  of  the  attempts  belongs  none 
the  less  to  it.  Originally  a  pest-house,  erected 
during  the  spread  of  the  plague  in  1709-17  lo,  by 
King  Frederick  I.,  at  his  own  expense,  but  not 
actually  used  as  such  because  the  epidemic  did 
not  reach  as  far  as  Berlin;  then  a  workhouse; 
next  a  lazaretto  or  military  hospital,  with  some 
wards  also  for  civilians,  not  until  1727  did  it  receive 
the  name  of  the  Charite.  Frederick  AYilliam  then 
endowed  it  and  devoted  it  to  educational  purposes. 
In  1737  its  internal  organisation  was  regulated  and 
its  six  divisions,  the  military  wards,  medical  and 
.surgical  civil  departments,  syphilitic,  obstetrical, 
and    skin    departments,  were   systematised    with 


Kaiserswerth  and  the  Deaconess     27 

the  double  purpose  of  charity  and  instruction. 
It  had  then  200  beds.  The  attendants  were  men 
and  women  of  purely  secular  character,  and  il- 
literate. For  every  small  medical  ward  there 
was  one  woman  attendant,  and  for  two  surgical 
wards,  one. 

The  whole  edifice  was  rebuilt  in  1785,  and  the 
asylum  for  the  insane  added  to  it. 

The  nursing  question  was  early  considered  and 
the  necessity  for  raising  the  standard  recognised. 
The  experiment  of  improving  the  food  and  the 
pay  was  tried;  the  discipline  was  military,  and 
the  wards  were  improved  in  some  respects. 
In  1830  the  Krankenw drier  Schule,  or  course  of 
instruction  for  attendants,  was  established.^  As, 
however,  the  whole  nursing  system  was  wrong 
fundamentally  and  throughout,  the  results  could 
not  be  good. 

For  some  fifty  years  after  the  first  entrance  of 
the  deaconesses  into  its  wards,  the  Charite  was 
nursed  on  a  plan  which  seems  to  us  clumsy  and 
complicated.  Beside  its  own  nurse- attendants, 
it  engaged  groups  of  deaconesses  for  the  care 
of  special  wards.  If  one  Motherhouse  (as  was 
often  the  case)  could  not  supply  enough,  another 
one  was  applied  to,  and  thus  in  time  groups  of 
nurses  from  several  training  institutions  or  Mother- 
houses  were  on  duty  at  the  same  time  in  different 
divisions  of  the  hospital,  each  group  being  under 
its  own  supervising  Sister.     There   was  no  one 

»  Annalen  des  Charite  Krankenhaus  zu  Berlin,   1850. 


28  A  History  of  Nursing 

woman  head  for  these  different  groups,  but  they 
Hved  together  as  separate  families,  each  under  the 
final  control  of  the  institute  which  sent  them. 
One  can  hardly  imagine  a  more  effective  way  oi 
preventing  unity   of   administration.^ 

Mother  Caroline  Fliedner  was  a  character  of 
great  force  and  sweetness.  She  was  described  as 
*'  a  joyous  child  full  of  gaiety,  of  strong  will,  and 
with  great  consideration  for  all  around  her.  2  She 
was  of  a  Huguenot  family  that  had  been  exiled  in 
1685  from  France  and  had  settled  in  Hamburg. 
She  was  born  in  181 1  and  had  been  educated  by 
Amalie,  who  delighted  in  training  young  girls 
to  have  ideals  of  social  usefulness.  She  had  been 
perusaded  by  her  preceptress  to  enter  the  General 
hospital  to  conduct  a  reformation  in  the  nursing, 
and  had  been  at  work  there  for  three  years.  Dur- 
ing her  long  administration  of  Kaisers werth  her 
great  energy,  practical  ability,  and  genuine  char- 
acter commanded  the  respect,  admiration,  and 
love  of  all  "from  high  to  low."  It  was  said  of 
her  by  a  pastor  that  whenever  difficult  problems 
came  before  the  management,  and  she  was  called 
upon  to  give  her  opinion,  she  always  waited  long 
before  speaking,  but  that  when  she  spoke  "her 
words  were  so  direct,  her  reasons  so  convincing, 
and  her  solution  of  the  difficulty  so  simple  that 

»  At  the  present  time  the  Charity  is  estabhshing  a  training 
school  on  modem  Hnes,  or  at  least  making  the  attempt. 

^  Mutter  Fliedner:  zum  Geddchtniss.  Kaiserswerth  am 
Rhein,  1892. 


Kaiserswerth  and  the  Deaconess     29 

all  instantly  agreed  with  her."  ^  She  gave  up 
the  work  in  1884,  but  lived  ten  years  longer,  her 
raind  keen  and  alert,  her  heart  as  warm  as  ever. 

The  annual  reports  during  the  lifetime  of 
pastor  Fliedner  are  full  of  side-lights  on  the  nursing 
work  of  the  Mother  house.  The  ''Mother"  or 
Superintendent  is  often  spoken  of  as  directing  all 
the  work  and  developing  new  fields.  As  early  as 
the  fourth  report  the  need  of  better  preparatory 
education  for  the  pupils  has  been  felt,  and  the 
hope  is  expressed  that  in  the  coming  year  some- 
thing may  be  done  to  fill  this  want.  In  this  report 
also  Mrs.  Fry's  visit  is  mentioned  and  joy  expressed 
at  having  heard  from  her  of  the  beginning  of  her 
own  "Nursing  Sisterhood"  on  her  return  to  Eng- 
land. In  the  fifth,  mention  is  made  of  several 
pupils  having  been  sent  from  France  and  Switzer- 
land to  be  trained  at  Kaiserswerth.  It  was  from 
the  outset  regarded  by  the  Fliedners  as  most 
desirable  and  important  that  room  should  be 
made  for  and  opportunity  given  to  persons  desir- 
ing to  come  for  a  time  to  study  the  methods  of 
Kaiserswerth. 

In  view  of  this  well-known  attitude  of  pastor 
Fliedner  and  his  wife  toward  students  who  might 
help  in  spreading  the  new  system,  the  story  some- 
times told  that  pastor  Fliedner  at  first  refused  to 
consider  Miss   Nightingale's   application,   on  the 

>  From  Life  of  Pastor  Fliedner,  translated  from  the  German 
by  Catherine  Winkworth,  London,  1867,  p.  85.  Authorised 
by  his  family  and  published  in  Kaiserswerth,  1866. 


30  A  History  of  Nursing 

ground  that  she  was  too  refined  and  dehcate, 
and  that  he  required  her  to  get  down  and  scrub 
a  floor  before  admitting  her  to  training,  seems  a 
Httle  apocryphal.  No  doubt  she  had  to  scrub 
floors — that  was  part  of  the  work. 

In  the  sixth  report  the  probation  time  has  been 
developed  by  placing  a  teaching  Sister  in  special 
charge  of  the  probationers,  who  now  have  a  hall 
to  themselves  and  are  taught  and  prepared  for 
their  duties.  The  orphanage  has  been  started, 
and  children  of  respectable  families  are  to  be 
given  a  good  plain  education,  and  allowed  to 
select  their  callings.  It  is  hoped  that  some  will 
be  attracted  to  the  nursing.  Plans  for  district 
nursing    (Gemeindepflege)    are   now  projected. 

The  eighth  report  speaks  of  the  successful  plant- 
ing of  district  nursing  work  in  two  parishes,  Biele- 
feld and  Cleve,  in  the  previous  year,  and  this 
extension  is  regarded  with  the  fondest  hope  and 
joy.  Several  years  later  Cologne  and  Elberfeld 
have  district  nurses.  In  the  morning  they  pre- 
pare nourishment  for  a  number  of  poor  and  sick, 
and  in  the  afternoon  they  visit  and  nurse.  In 
Cleve  the  two  district  nurses  have  a  little  home 
hospital,  and  receive  there  several  very  sick 
patients.  They  have  also  under  their  charge  a 
school  of  sewing  and  embroidery  for  destitute  girls. 
At  this  time  pastor  Fliedner  speaks  of  having  to 
refuse  to  permit  the  district  nurses  to  do  night 
duty.  He  has  now  had  to  give  up  church  and 
parish  and  devote  himself  entirely  to  the  business 


"  Mother"  Caroline  Fliedner 

From     Jahrhuch    fiir     CJu'istliche     Unterhaltung,^ 

Kaisersweith,  1894 


Kaiserswerth  and  the  Deaconess     31 


of  developing  the  district  work.  In  the  growth 
of  the  Motherhouse  there  is  now  a  Probe- 
Schwester  (the  "  Home  Sister"  of  the  later  English 
schools)  in  charge  of  the  probationers,  and  two 
teaching  Sisters  who  give  them  instruction.  In 
1850  mention  is  made  in  the  reports  of  several 
Sisters  sent  to  pastor  Passavant  in  Pittsburg,  in 
far-off  America,  whither  Fliedner  himself  had  jour- 
neyed with  them.  There  had  been  typhus  and 
cholera  epidemics,  and  their  record  was  admirable. 
They  had  hoped  to  establish  a  deaconess  Mother- 
house,  but  only  one  probationer  came.  Pastor 
Passavant  begged  for  more  Sisters  to  be  sent, 
even  offering  to  pay  all  their  expenses ;  but  Flied- 
ner refused,  saying  that  he  had  given  them  enough 
deaconesses  to  teach  and  train  a  new  set,  and  they 
must  find  their  own  probationers.  The  need  of  the 
deaconesses'  work  in  the  United  States  was  the  sub- 
ject of  many  discussions  in  Lutheran  synods  of  that 
year.  In  this  report  also  (1850)  Miss  Nightingale 
is  mentioned  as  having  come  for  some  weeks,  also 
a  Swedish  and  a  Russian  lady.  In  1856  Miss 
Nightingale  is  again  mentioned.  She  had  given 
the  Constantinople  Deaconesses'  hospital  thirteen 
beds  and  enough  linen  for  forty  patients.  The 
twentieth  annual  report  is  signed  by  a  committee. 
Pastor  Fliedner  is  travelling  in  the  East,  partly 
to  inspect  the  branch  houses  and  partly,  but  in 
vain,  trying  to  shake  off  the  ill-health  to  which  he 
finally  succumbed. 

The  principle  on  which  the  Fliedners  based  theii 


32  A  History  of  Nursing 

work  and  that  of  the  newly  revived  order  of 
deaconesses  was  that  of  jo}^'ul  ser^4ce  springing 
from  self-sacrificing  love,  the  old,  old  idea  of  the 
salvation  of  the  world  through  the  might  of 
regenerating  love — interpreted  after  one  manner 
by  the  doctrinaires,  after  another  by  poets,  art- 
ists, and  musicians,  and  still  another  by  thousands 
of  obscure  hearts.  Theirs  was  a  beautiful  and 
a  beneficent  purpose.  Indirectly,  viewed  from 
the  modern  standpoint  of  the  progress  so  far 
made  toward  the  emancipation  of  women,  the 
revival  of  the  evangelical  deaconess  order  was  a 
most  important  and  significant  movement.  It 
was  the  first  step  in  a  slow  series  which  had  to 
be  taken  to  release  women  from  the  narrow  and 
cramping  social  bondage  in  which,  unless  they 
had  independent  means,  they  were  held  at  that 
period, — a  period  which  did  not  educate  them, 
which  hardly  allowed  them  to  earn  their  living 
unless  they  belonged  to  the  lovrest  social  ranks, 
and  which  permitted  them  little  or  no  inde- 
pendence or  initiative.  Although  hers  was  a 
strict  and  in  many  respects  a  narrow  discipline 
the  deaconess  was  far  freer  than  her  sister  the  nun, 
and  had  a  more  natural  life.  Though  she  was 
only  supported  and  not  paid,  this  was  nevertheless 
a  tremendous  advance  over  being  permitted  no 
occupation.  The  deaconess  movement  supplied 
the  first  great  general  school  for  improving  the 
practical  training  of  Protestant  women  for  useful 
work,  and  was  the  pioneer  in  bringing  to  a  highly 


Kaiserswerth  and  the  Deaconess 


OJ 


conservative  and  narrow  social  order  the  idea  that 
every  form  of  labour  was  honourable  and  dignified. 
Pastor  Fliedner  himself  summed  up  the  essentials 
of  organised  life  as  developed  in  Kaiserswerth  as 
follows : 

In  organisation  the  work  was  a  free  religious  as- 
sociation, not  dependent  on  state  or  church  authori- 
ties. It  takes  its  stand  on  the  mother  nature  of  the 
church  founded  by  Christ. 

Two  errors  were  avoided:  i.e.  i.  Conventual  vows 
or  a  contemplative  ascetic  character,  and  2,  decen- 
tralisation. The  Kaiserswerth  deaconesses  after 
five  years  of  service  were  to  be  free  to  return  home  or 
to  marry.  The  Motherhouse  is  a  democratic  family 
and  the  deaconesses  have  a  voice  in  choosing  their 
superiors  or  heads.  The  Motherhouse  must  be  a 
protection  and  home  for  all  the  members,  so  it  retains 
final  authority  over  all  members  in  outlying  places 
and  the  right  to  call  them  back. 

The  work  is  regarded  as  in  four  branches  with 
sub-branches : 

(  acute 
Hospital  •<  chronic 

(  special 
Private  nursing 

Parish  or  district,  i.e.  visiting  nurs- 
ing. 
'  Orphanages 
Homes  for   aged  and  infirm 
Distribution  of    sewing  and 

handwork 
Almshouses 

Asylums   for  the  blind,  etc. 
Training  homes  and  bureaus 
for  servants. 


A.  Nursing 


B.  Relief  of  Poor 


34  A  History  of  Nursing 


{ 


Schools  for  little  children 
Schools  for  girls 
C.   Care  of  Children   ^' Training  schools  for  teachers 
Manual  training  schools 
!  Special    teaching    for    insti- 
tutions for  the  blind ,  etc. 


D.  Work  among  Unfortunate  Women  j  ,  ^  ^    ,  , 

Pastor  Fliedner  was  a  trul^  remarkable  man; 
— great  in  his  large  heart,  his  true,  fervent,  and 
simple  piety,  his  vast  energy  and  practical  effi- 
ciency. No  man  had  more  ideal  helpers  in  his 
two  wives,  but  he  deserved  them,  for  he  placed 
women  high,  recognised  their  abilities,  and  wil- 
ingly  accorded  them  full  authority  in  their 
domain.  He  was  one  of  the  first  to  advocate  the 
introduction  of  women  as  teachers  into  the  public 
schools,  against  which  there  was  then  a  strong 
conservative  prejudice,  and  he  established  a 
normal  school  for  girls  as  one  of  the  Kaiserswerth 
institutions.  The  striking  feature  of  the  Kaisers- 
werth administration  was  the  -^^se  and  humane 
treatment  of  their  inmates  as  individuals.  In  the 
intelligent  use  of  occupation,  diversion,  and  cheer- 
fulness they  were  far  ahead  of  their  time.  The 
amusements  and  instruction  of  convalescent  chil- 
dren, adults,  and  defectives  were  early  thought 
out  w4th  care  and  wisdom.  The  children  were 
taught  reading,  writing,  accounts,  singing,  story- 
telling, and  organised  play.  The  older  patients 
were  taught  a  number  of  hand  industries,  such 
as  knitting,  net-making,  weaving,  and  box-making, 


I 


Kaiserswerth  and  the  Deaconess     35 

and  had  light  work  in  the  garden.  Illiterate  con- 
valescents were  taught  reading  and  writing,  and 
singing  was  regarded  as  a  universal  necessity. 

The  formal  charter  of  incorporation  for  the 
Kaiserswerth  Deaconesses'  Institution  had  been 
granted  by  a  ministerial  order  on  November  20, 
1846,  ten  years  after  the  beginning  of  the  work, 
and  an  affiliation  of  Motherhouses — which  were 
either  organically  related  to  or  in  full  sympathy 
with  it,  and  so  desirous  of  supporting  and  being 
supported  by  it — was  a  further  effort  of  Fliedner's 
organising  genius.  This  affiliated  body,  called 
the  Kaiserswerth  General  Conference  of  Mother- 
houses,  meets  triennially  at  Kaiserswerth  and  its 
reports  show,  as  pastor  Golder  writes, 

the  exceedingly  great  scope  of  activity  in  an  army 
of  more  than  thirteen  thousand  deaconesses.  There 
is  no  kind  of  human  misery  that  it  does  not  reach. 
They  serve  with  loving  hearts,  wise  discretion,  and 
skilful  hands  the  sick  of  every  condition — epileptics, 
the  imbecile,  lepers,  and  lunatics;  neglected  children 
and  abandoned  infants;  the  crippled,  aged,  fallen 
women;  incarcerated;  orphans;  servants  out  of  em- 
ployment; unattended  children;  young  girls,  and  a 
number  of  others  in  need. 

It  is  impossible  not  to  be  struck  with  the  general 
resemblance  between  the  deaconess  movement 
and  that  of  the  Sisters  of  Charity,  and  by 
certain  features  in  common  in  the  characters  of 
Vincent  de  Paul  and  pastor  Fliedner.  Different 
as  their  personalities  were,  both  were  alike  in  the 


36  A  History  of  Nursing 

rare  simplicity  and  humility  of  their  unaffected 
piety ;  in  their  complete  self-f orgetf  ulness,  their  un- 
unflagging  and  active  concern  for  human  misery; 
in  their  immense  energ}^  in  their  organising  and 
administrative  ability.  These  two  men,  like 
Lambert  le  Begue,  knew  how  to  call  forth  and 
develop  useful  initiative  in  the  masses  around 
them;  how  to  focus  and  guide  it.  Their  great 
secret  of  management  lay  in  a  complete  absence 
of  repressive  force.  They  perpetually  encouraged 
and  never  discouraged  the  efforts  of  others.  In 
the  great  movements  of  human  activity  with 
which  their  names  are  associated  they  dealt  with 
women  and  men  on  the  same  plane,  showing  the 
former  the  same  respect  and  consideration  as  the 
latter.  In  a  word,  these  eminent  men  were 
entirely  free  from  all  narrowness  or  caste  feeling. 
The  women  in  these  two  great  movements, 
though  some  had  social  station  and  education, 
w^ere  alike  recruited  largely  from  the  peasant 
classes;  alike  they  taught,  toiled,  rescued,  visited, 
and  nursed,  and  in  war  followed  their  country's 
flag.  Though  arrayed  under  different  religious 
formulas,  these  were  essentially  the  same  women, 
animated  by  the  same  spirit  and  enjoying  alike  the 
love  and  regard  of  the  people.  The  Kaiserswerth 
deaconesses,  like  the  Sisters  of  Charity,  were 
always  on  the  spot  where  there  was  pestilence  or 
misery.  In  1848,  when  the  hunger  typhus  deci- 
mated Altdorf,  they  were  there,  and  in  1849 
they  nursed  the  cholera  patients  in  a  number  of 


Kaiserswerth  and  the  Deaconess     37 

small  towns.  After  the  war  of  1864  small-pox 
broke  out  both  in  hospitals  and  in  country  regions. 
The  deaconesses  found  the  peasants  in  their 
cottages,  often  without  beds,  on  the  floor  or  on 
piles  of  straw  covered  w4th  rags,  while  the  cows 
and  pigs  inhabited  a  part  of  the  dwelling,  or  a 
group  of  farmhands  shared  the  sick-room.  For 
nearly  two  years  they  struggled  with  small-pox 
under  such  conditions,  caring  for  more  than  1000 
cases  in  all.  Then  war  broke  out  again,  followed 
by  cholera,  which  swept  the  land  in  a  way  hitherto 
unknown.  Thirty- five  deaconesses  worked  in 
more  than  twenty  localities,  nursing  over  1000 
patients,  and  as  the  cholera  died  away  true  typhus 
fever  broke  out  in  East  Prussia,  and  eight  of  the 
deaconesses  hastened  thither  to  the  pest-houses. 
Thereafter  there  was  hardly  a  period  when  some 
of  the  Sisters  were  not  campaigning  against 
contagion,  and  w^hen  the  alarming  epidemic  of 
cholera  raged  in  Hamburg,  in  1892,  fifteen  of 
their  number  went  to  the  General  City  Hospital, 
where  they  worked  night  and  day,  in  the  very 
wards  where  their  second  mother,  Caroline,  had 
served  as  a  volunteer  nurse  in  her  youth.  As  in 
epidemics,  so  in  the  wars  of  1861,  1864,  1866,  and 
1870  to  1871,  the  deaconesses  of  Kaiserswerth 
were  conspicuously  active.  They  served  not 
only  in  the  hospitals,  but  on  the  very  fields  of 
battle,  and,  accompanied  by  a  guard  of  Uhlans, 
they  followed  the  Prussian  army  in  every  ad- 
vance.    In  all,  they  served,  in  1870,  in  more  than 


182702 


38  A  History  of  Nursing 

sixty  military  hospitals,  and  over  30,000  soldiers 
passed  through  their  wards. 

Beside  its  numerous  integral  branches,  Kaisers- 
werth  at  different  times  organised  and  gave  over 
into  other  hands  for  independent  management 
no  less  than  79  different  institutions,  34  of  which 
were  hospitals  and  9  deaconess  houses.  After  the 
successful  demonstration  of  the  Fliedners  there 
was  a  general  movement  of  active  imitation,  and 
not  a  year  passed  that  new  Motherhouses  were 
not  established.  The  hospitals  which  they  erected 
set  a  new  standard  in  hospital  work,  construction, 
management,  and  nursing.  The  Motherhouse 
did  not  look  upon  its  patients  as  cases  only,  but 
as  human  individuals,  each  one  needing  kindness 
and  consolation  as  well  as  scientific  treatment. 
Their  wards,  though  plain,  were  homelike  and 
cheerful,  and  as  the  Sisters  were  called  into  the 
great  city  hospitals  they  introduced  there  the  same 
atmosphere,  and  effected  that  moral  renovation 
which  has  so  strikingly  accompanied  the  entrance 
into  hospitals  of  women  of  character  armed  with  au- 
thority,wherever  they  have  gone,  and  which,  though 
often  overlooked,  has  perhaps  been  a  contribution 
of  even  greater  value  than  their  more  obvious, 
technical  achievements  as  handmaidens  of  science. 

An  excellent  exposition  of  the  generally  accepted 
fimdamental  principles  in  the  training  of  deacon- 
esses is  given  by  Schafer.  ^      Preeminent  was  the 


1  Die   Weibliclie   Diakonie,   vol.    3.     The  whole   volume    is 
given  to  this  subject. 


* 


Kaiserswerth  and  the  Deaconess     39 

idea  that  the  deaconess  was  not  to  be  a  narrow 
speciaHst  in  any  one  Hne,  but  was  to  have  an  all- 
round  preparation.  While  her  talents  and  in- 
clinations were  consulted  in  placing  her  in  positions 
after  her  training,  yet  she  was  not  to  be  only  a 
nurse,  or  only  a  teacher,  or  only  a  parish  worker, 
but  ready  to  do  anything.  No  form  of  human 
need  in  which  a  woman's  strength  could  be  exerted 
was  to  be  excluded  from  her  province.  Her 
religious  duty  was  foremost:  "The  most  precious 
duty  of  the  deaconess  is  to  lead  the  ungodly  into 
the  church,"  and  every  deaconess,  no  matter  what 
her  work,  must  give  testimony  of  her  faith.  She 
was  not,  however,  to  proselytise  those  of  other 
religious  beliefs.  All  her  work  should  be  done 
in  the  name  of  the  Lord.  Therefore  she  needed 
the  continual  guidance  of  the  pastor,  and  the 
latter  must  not  only  not  ignore  her  but  must 
oversee  and  guide  her.  And  not  alone  the  dea- 
coness in  district  nursing  or  parish  visiting,  but 
he  must  oversee  every  deaconess  in  his  entire 
field  of  labour,  whether  in  hospitals  or  other  in- 
stitutions. Equally  the  training  school  can  have 
no  objection  when  the  pastor  makes  it  his  business 
to  concern  himself  with  deaconesses  who  are  doing 
private  duty  in  well-to-do  families. 

While  the  pastors  did  not  uphold  celibacy  as  a 
tenet,  they  urged  the  deaconess  to  make  her  calling 
a  life-work,  and  boldly  taught  that  marriage  was 
not  the  only  nor  even  the  noblest  sphere  of  woman, 
and  that,  as  there  were  always  more  women  than 


40  A  History  of  Nursing 

men,  God  could  not  have  intended  marriage  as 
their  only  portion.  The  deaconess,  as  has  been 
mentioned,  after  five  years  of  service  was  free  to 
marry  or  to  return  to  her  family,  and  she  retained 
the  control  of  any  property  of  which  she  might  be 
possessed. 

It  is  interesting  to  see  how  much  of  their  sys- 
tem and  detail  our  modern  training  schools  have 
inherited  from  the  IMotherhouse — the  probation- 
ary system,  and  the  school  for  preparatory  train- 
ing; the  letters  from  clerg^^man  and  physician 
as  to  character  and  health;  the  allowance  of 
pocket-money;  the  grading  of  work,  from  easy  tc 
difficult;  the  chain  of  responsibility;  the  grading 
of  pupils  from  probationer  to  head  nurse,  with  the 
superintendent  at  the  head;  the  class- work  and 
lectures;  and  every  principle  of  discipline,  eti- 
quette, and  ethics.  The  combination  of  a  semii- 
military  form  of  professional  discipline  w4th  social 
equality,  found  in  the  Motherhouse,  gSive  the 
pattern  to  the  early  American  schools  even  more 
than  did  the  first  English  schools,  whose  system 
of  class  distinctions  was  never  established  in 
America.  From  the  first  the  probationer  was 
taken  into  the  housewifely  departments  under 
the  eye  of  a  head  sister  (Probe  Sch wester) . 

Kaiserswerth  established  a  preparatory  school 
for  its  probationers  in  1865.  This  was  to  supply 
deficiencies  in  family  training  or  in  education, 
but  chiefly  to  develop  their  characters,  and  pre- 
vent them  from  being  "institutionalised"  at  an 


I 


Kaiserswerth  and  the  Deaconess     41 


early  age.  Pupils  were  taken  into  the  prepara- 
tory school  between  the  fourteenth  and  eighteenth 
years.  Other  Motherhouses  followed  this  ex- 
ample. The  time  spent  in  preparatory  work 
varied  in  accordance  with  the  character,  education, 
and  age  of  the  pupil,  from  three  months  to  a 
year  or  more.  At  eighteen  they  were  admitted 
as  probationers.  Continuous  and  systematic  in- 
struction was  regarded  as  indispensable.  There 
was  a  difference  of  opinion  as  to  the  rougher  parts 
of  the  housework,  some  pastors  holding  that  once 
learned  it  should  not  be  continuously  performed 
by  the  deaconesses,  but  that  hired  maids  should 
save  their  strength  for  more  responsible  work; 
practically,  for  want  of  means,  this  was  almost 
never  done,  and  all  washing,  ironing,  and  heavy 
housework  was  usually  shared  by  the  Sisters. 
(This  question  of  housework  with  nursing  has 
been  of  never-ceasing  interest  to  pastors  who 
write  on  training,  and  one  very  successful  or- 
ganiser. Dr.  Zimmer,  gives  his  experience  as  in 
favour  of  having  no  maids  or  cleaners  at  all,  as  he 
thinks  the  change  from  nursing  to  housework 
healthful,  refreshing,  and  good  for  the  nurses, 
and  gives  them  an  opportunity  to  develop  all  their 
energy.)  For  training  it  was  held  that  a  not  too 
large  hospital  was  best,  and  great  stress  was  laid 
on  the  necessity  of  having  a  spacious  garden  where 
the  Sisters  could  walk  and  rest.  Cheerfulness 
was  regarded  as  an  essential  characteristic  of  the 
pupil.     Gloomy    and    despondent   temperaments 


42  A  History  of  Nursing 

(it  was  held)  were  unfit  for  the  work,  and  selfish- 
ness made  a  life  lived  in  common  impossible.  The 
Motherhouse  was  regarded  as  a  family  home; 
the  pastor  and  the  Oberin  (lady  superintendent) 
corresponded  to  the  father  and  mother,  and  the 
deaconesses  to  the  children.  Excessive  intimacies 
between  deaconesses  were  considered  harmful  to 
character,  and  were  regarded  with  fixed  disap- 
proval, such  pupils  being  systematically  separated. 
The  importance  of  the  head  Sister's  office  was 
well  recognised.  It  was  important  that  head 
nurses  should  teach  and  not  only  do  things  well 
themselves;  inasmuch  as  it  requires  more  char- 
acter to  be  able  to  get  good  work  from  others 
than  to  do  everything  one's  self.  A  good  Sister 
would  always  instruct  the  younger  ones.  The 
rules  fixing  the  relationship  of  the  deaconess  to 
the  physician  were  strict.  She  must  be  his  as- 
sistant, not  presuming  herself  to  act  as  a  physician 
but  she  might  act  independently  of  him  in  an 
emergency.  "  In  all  which  concerns  the  care  of 
the  patient  she  is  bound  to  obedience  toward  the 
doctor  and  to  faithful  loyalty.  She  must  beware 
of  any  self-assertion  or  independence.  If  the 
doctor's  orders  are  mistaken  or  harmful  the  Sister 
does  not  bear  the  responsibility."  But,  what  is 
interesting,  ethical  difficulties  are  provided  for: 
**  Experienced  nurses  have  the  right  to  remon- 
strate quietly  and  tactfully  with  physicians,  but 
not  directly  to  oppose  them."  The  physician 
on  his  part  was  to  regard  the  hospital  as  a  place  for 


Kaiserswerth  and  the  Deaconess     43 

teaching  the  Sisters.  He  must  not  only  treat  the 
patients,  but  remember  that  the  training  of  the 
deaconess  makes  it  essential  that  she  should 
work  in  turn  in  all  the  different  departments  of 
the  hospital.  Shafer  makes  it  clear  that  the 
physician  has  nothing  to  do  with  the  management 
of  the  Sisters.  Their  discipline,  the  distribution 
of  work,  and  changing  the  pupils  from  one  ward 
to  another  is  the  business  of  the  matron.  As  to 
the  managers,  it  was  held  most  important  that  they 
should  never  interfere  in  the  internal  management 
of  affairs.  These  must  be  conducted  entirely  by 
the  matron  and  the  pastor.  The  managers  should 
choose  these  two  officers  with  great  care,  and 
then  leave  them  unhampered.  As  to  the  institu- 
tions connected  with  the  Motherhouse  (and  this 
is  also  quite  striking),  the  accepted  view  was  not 
that  the  Motherhouse  was  there  for  the  sake  of 
the  institutions,  but  that  the  latter  were  there  for 
the  sake  of  the  Motherhouse,  to  provide  suitable 
places  to  teach  the  Sisters.  The  daily  schedule 
of  work  was  about  as  follows:  The  deaconesses 
rose  at  5,  and  went  to  the  wards,  where  they 
worked  until  6.15  or  6.30,  when  the  patients  had 
their  breakfast ;  they  then  had  fifteen  minutes  for 
their  coffee,  followed  by  prayers  for  twenty-five 
minutes.  The  physicians'  rounds  were  at  8. 
At  9  there  was  a  second  breakfast  for  the  pa- 
tients and  nurses,  then  ward- work  and  operations 
until  lunch  or  dinner  at  12  or  12.30.  There  was 
then  a  resting  time  (if  they  could  take  it) ,  part 


44  A  History  of  Nursing 

of  which  was  the  quiet  half-hour  spent  in  the 
chapel.  From  2  to  3  p.m.  there  were  lessons 
and  study,  then  ward-work  again,  religious  teach- 
ing by  the  pastor  at  7,  and  ward- work  until  9, 
then  prayers  and  bed.  The  general  custom  for 
night  duty  was  for  the  day  nurses  to  divide 
the  night  serv^ice  in  turn.  Thus  of  two  day 
nurses  one  stayed  on  until  midnight  and  the  sec- 
ond came  for  the  rest  of  the  time.  With  this  plan 
the  turn  came  around  to  each  one  about  once  a 
week;  but,  though  there  was  not  any  or  but 
little  extra  rest  in  the  day,  the  work  was  not 
thought  hard  enough  to  be  prejudicial  to  health. 
Some  Motherhouses  had  a  regular  staff  of  night 
nurses,  who  did  one  month's  duty  at  a  time. 
There  was  always  a  night  Sister  in  charge.  On 
private  duty  the  Motherhouse  requested  that 
deaconesses  should  have  their  meals  served  to 
them  alone  if  they  did  not  go  to  the  family  table. 
They  were  not  to  eat  in  the  kitchen.  They  were 
to  have  at  least  four  or  five  hours  iminterrupted 
sleep  and  an  hour  in  the  fresh  air  daily.  Dea- 
conesses who  WTre  nursing  men  must  have  an 
orderly  or  male  assistant. 

District  work  was  regarded  as  the  flower  of 
nursing.  The  cardinal  virtue  of  a  district  nurse 
was  "practical  wisdom"  to  grasp  and  compre- 
hend; to  sympathise,  to  regulate  and  order,  to 
discriminate  between  the  true  and  false,  to  pene- 
trate to  causes;  to  plan  for  regeneration.  She 
must  have  intellectual  mobility,  combined  with 


Kaiserswerth  and  the  Deaconess     45 

quiet  persistence  and  effectiveness.  Slow  Sisters 
who  are  never  through  with  their  work  are  not 
good  for  district  nursing. 

Leaving  aside  all  local  and  transitory  features 
it  cannot  but  be  recognized  that  the  early  Mother- 
houses,  following  the  lead  of  Kaiserswerth,  laid 
down  every  fundamental  principle  of  good  train- 
ing. Many  pastors  wrote  with  great  good  sense 
on  methods  and  principles,  having  learned  them 
from  Friederike  and  Caroline  Fliedner.  It  is 
noticeable  that  the  pastors,  far  more  than  the 
physicians  of  that  time,  acquiesced  in  the  large  and 
responsible  position  to  be  held  by  the  woman  head 
and  the  share  of  authority  to  be  given  her.  Not 
the  least  of  the  services  rendered  to  good  nursing 
by  the  Mother  houses  was  the  restoration  of  the 
woman  superintendent  or  matron,  who  had  been 
eliminated  by  the  management  of  civil  hospitals 
in  their  system  of  servant -nurses  under  masculine 
officials.  The  extinction  of  the  matron,  still 
strikingly  noticeable  in  the  great  hospitals  of 
Germany,  France,  and  Austria,  made  a  well-bal- 
anced training  and  discipline  impossible  in  civil 
hospitals;  the  control  of  the  nurses,  scattered 
among  various  male  officials,  was  lost ;  high  stand- 
ards were  not  thought  of,  teaching  disappeared, 
slovenliness  was  the  rule,  immorality  was  fre- 
quent, and  the  patients  were  the  sufferers. 

The  value  of  the  matron  as  a  key -stone  was 
shown  in  every  fresh  work  of  the  Motherhouse, 
and  even  more  prominently  by  the  reform  of  the 


46  A  History  of  Nursing 

English  hospitals  under  Miss  Nightingale.  The 
results  stand  in  striking  contrast  with  the  de- 
plorable conditions  existing  in  such  hospitals  as 
the  Charite,  the  Vienna  General,  and  the  great 
Paris   hospitals   immediately   after   laicisation. 

It  must  also  be  noted  that,  as  a  result  of  ac- 
cepting the  authority  of  the  matron,  the  German 
pastors  were  far  in  advance  of  the  German  phy- 
sicians of  that  time  in  the  recognition  of  Miss 
Nightingale's  services  for  the  elevation  of  nursing. 
Her  books  were  translated  into  German,  and  her 
teachings  are  freely  quoted  by  Schafer  and  others. 

We  do  not  attempt  to  follow  the  great  extension 
and  duplication  of  the  deaconess  Motherhouses 
through  the  sixty  years  following  the  foundation 
of  Kaiserswerth,  as  there  are  m_any  excellent 
reference  books  available  which  give  careful  de- 
tails of  the  numerous  fields  of  work  and  institu- 
tions both  affiliated  with  and  independent  of  it.  ^ 

That  feature  of  the  subsequent  development 
of  the  female  diaconate  which  belongs  to  our 
subject  is  its  relation  to  nursing.  As  time  went 
on  and  competition  entered  undeniably  into  the 
field  of  the  deaconess  work,  much  of  the  early 
zeal  and  freshness  wore  off  and  a  greater  rigidity 
entered  into  the  life.  The  economic  problem  w^as 
ever  present,  and  the  maintenance  of  this  large 
body  of  workers  had  necessarily  to  be  of  the  spars- 
est character.  The  immediate  control  of  do- 
mestic and  nursing  details  fell  more  and    more 

»  See  Appendix  for  bibliography. 


Kaiserswerth  and  the  Deaconess     47 

(not  accidentally)  into  the  hands  of  the  pastors, 
who  believed  they  had  learned  enough  to  be  able 
successfully  to  manage  this  part  of  the  system. 
Women  were  taken  on  younger  and  younger,  and 
overwork  of  a  severe  and  often  cruel  character 
became  common. 

The  necessity  of  earning  money  by  sending  the 
nurses  out  to  hospital  service  often  quite  put  an 
end  to  careful  training.  Women  of  a  superior 
ability  were  less  and  less  attracted  to  the  calling 
and  the  ranks  remained  largely  filled  from  the 
peasant  class.  The  occasional  devoutly  religious 
aristocrat  who  entered  a  Motherhouse,  and  w^ho 
thereby  received  much  adulation  from  the  pens 
of  chroniclers,  invariably  entered  upon  the  posi- 
tion of  superintendent,  for  which  she  had  often 
fitted  herself  but  superficially,  by  a  practical 
apprenticeship  of  a  much  briefer  sort  than  that 
gone  through  by  the  average  Sister.  Thus  little 
by  little  the  practical  ability  of  the  women  heads 
to  teach  the  probationers  fell  below  par,  and  the 
numerous  members  of  the  medical  profession  who 
were  not  in  sympathy  with  the  deaconess  move- 
ment were  able  to  claim  with  truth  that  the 
matrons  were  not  competent  to  teach  nursing, 
and  thus  press  a  disposition  to  dispense  with 
them  entirely.  The  increasing  prominence  of  the 
pastors  was  also  most  obnoxious  to  medical  men. 
Physicians  declared  their  hostility  to  them  on  the 
grounds  that  they  interfered  with  the  complete 
subordination    of    the  nurse  to    the    physician; 


48  A  History  of  Nursing 

that  they  told  the  deaconesses  there  were  certain 
medical  orders  that  could  not  be  obeyed,  such  as 
telling  patients  untruths  about  their  condition, 
about  the  safety  of  operation,  etc.  The  pastors 
were  also  opposed  to  the  use  of  narcotics.  Certain 
physicians  expressed  themselves  strongly  in  maga- 
zine articles  and  said  that  the  pastors  had  no 
right  or  reason  in  nursing  affairs,  and  others 
declared  as  emphatically  that  it  was  abstird  to  give 
the  Oberin  (matron)  an}^  place  in  a  nursing  system.  ^ 
Both  pastors  and  a  certain  proportion  of  phy- 
sicians were  equally  averse  to  dealing  \^ith  women 
of  force  and  original  ability  and  both  equally 
dreaded  the  well-educated  woman.  Freedom  of 
thought  became  a  thing  definitely  forbidden  in 
the  ^lotherhouses,  as  is  illustrated  by  the  personal 
testimony  to  the  v^-riters  by  a  one-time  deaconess, 
of  having  been  forbidden  to  read  the  works  of 
Schiller.  This  repression  of  the  intellectual  life 
is  also  amply  attested  by  innumerable  clerical  writ- 
ings,2  and  a  certain  aversion  to  a  high  educational 
standard  is  equally  clearly  attested  in  writings 
of  physicians,^  though  these  were  perhaps  not 
in  the  majority. 

>  See  Fursorge  aiif  dem  Gehiete  der  Krankenwartung,  in 
Handbiich  der  Krankenversorgung  luid  Krankenpfiege ,  Liebe. 
Jacobsohn,  and  Meyer,  vol.  ii.,  part  i.,  p.    174. 

2  See  bibliographies  in  Schafer,  Die  Weibliche  Diakonie, 
and  in  Liebe,  Jacobsohn,  and  Meyer. 

3  Fursorge  aiif  dem  Gebiete  des  Krankenpflege-Unterrichts, 
See  Liebe,  Jacobsohn,  and  Meyer  op.  cit,  vol.  ii.,  part  i., 
PP-   174-328. 


Kaiserswerth  and  the  Deaconess     49 

Strangely  characteristic  of  those  who  apply 
repression,  they  yet  felt  dissatisfied  with  their 
own  results  and  seriously  discussed  them  without 
perceiving  their  causal  relations.  Very  signifi- 
cant are  the  titles  of  papers  read  by  the  pastors 
of  deaconess  institutes  in  later  years,  such  as : 

Why  do  so  few  Pastors'  Daughters  devote  them- 
selves to  the  Calling  of  the  Deaconess? 

How  shall  we  gain  more  Sisters  for  the  Deaconess 
Calling? 

Means  of  Increasing  the  Numbers  of  Deaconesses 
and  of  Overcoming  Prejudice  against  the  Office. 

What  is  done  and  What  can  be  done  to  Preserve 
the  Sisters'  Physical  Strength? 

How  are  the  Deaconesses  to  be  Kept  in  the  right 
frame  of  Joy  in  their  Work  and  Guarded  from  Apathy 
and  Dulness? 

Of  certain  Present  or  Threatening  Defects  of  the 
Deaconess  Institutions, 

How  shall  the  Sisters  Protect  Themselves  from  the 
Dangers  of  the  Morphine  Habit? 

What  Dangers  to  the  Deaconess'  Calling  are  inci- 
dental to  Institution  Life  and  How  shall  we  Meet 
Them? 

What  is  Necessary  on  the  part  of  the  Directors  to 
Preserve  the  Health  of  the  Sisters  and  Guard  them 
against  Premature  Invalidism.^ 

The  narrowness  and  arbitrary  limitations  intro- 
duced little  by  little  into  the  deaconess'  life  could 
not  fail  to  strike  vigorous  and  reason -loving  minds 

1  Schafer,  op.  cit.,  vol.  i.,  Anmerkungen,  pp.  315-320. 

VOL.  II. 4 


50  A  History  of  Nursing 

unpleasantly,  and  the  whole  inner  atmosphere  and 
character  of  the  more  recent  training  and  dis- 
cipline have  been  set  forth  in  the  pages  of  a  very 
remarkable  book,  ^  which,  in  the  form  of  a  simple 
narrative  framed  on  nothing  more  exciting  than 
the  story  of  an  average  group  of  persons,  gives 
a  picture  of  the  deaconess  life  drawn  by  a  master 
hand  and  with  as  much  depth  of  human  feeling 
as  of  intellectual  perception.  Gabriele,  the  daugh- 
ter of  a  well-to-do  family,  and  "who  was  endowed 
richly  with  qualities  of  head  and  of  heart,  went, 
following  a  sane  and  balanced  yet  insistent  wish 
to  give  service,  to  a  deaconess  house  and  entered 
upon  the  training.  She  found  that  what  was 
arbitrarily  demanded  of  her,  above  and  beyond  the 
natural  claims  of  nursing  to  self-sacrifice,  was 
nothing  less  than  the  negation  of  her  whole  per- 
sonality, the  sacrifice  of  her  natural  relations  with 
the  outer  world,  the  renunciation  of  mental  recre- 
ation and  of  all  higher  education;  in  short,  the 
atrophy  of  her  individual  self. 

All  the  minutest  details  of  the  daily  life  are 
sketched  in  with  a  delicate  touch  and  sympathy, 
and  the  round  of  the  days  in  training  home  and 
hospital  wards  could  only  have  been  described 
by  one  who  had  lived  it  all.  The  character 
sketches  are  vivid  and  speaking;  each  one  seems 
drawn  from  the  life.  The  matron,  of  bounteous 
motherly  goodness,  but  a  little  removed  from  the 

»  Frei  ziim  Diensi,  by  Luise  Al^ensicedi  (L.  Annshagen). 
Ernest  Bredt,  Leipzig,   1904. 


Kaiserswerth  and  the  Deaconess     51 

close  immediate  touch  with  the  individual  pupils; 
the  assistants  and  Sisters;  the  probationers,  who 
always  tried  to  eat  two  rolls  in  the  short  breakfast 
time  allowed  them;  the  pastor,  chief  of  all  in- 
struction given  the  probationers,  who  gave  his 
own  daughters  every  social  and  family  pleasure 
in  his  power,  and  would  not  have  dreamed  of 
letting  them  become  deaconesses;  the  patients, 
even  the  porter  at  the  door — all  are  lifelike. 

As  Gabriele  looked  around  the  table  at  her  first 
meal,  she  saw  the  assembled  Sisters  looking  very 
•much  alike  in  their  uniforms : 

Peaceful  countenances — a  little  subdued  perhaps 
and  tired,  yet  a  readiness  for  jest  and  cheerfulness 
was  there.  Faces  of  good  intelligence,  showing  a 
little  indifference  to  the  impression  made  by  them 
on  others,  perhaps  a  little  indifference  in  general 
towards  all  persons  who  were  not  sick.  Or  was  this 
only  absorption  in  work,  and  overstrain,  which  was 
more  evident  as  they  sat  down?  Most  of  them  were 
pale  and  looked  as  if  they  needed  air,  while  others 
were  fresh  and  pretty,  not  unbecomingly  clad  in  the 
close  cap.  Close,  smooth,  scanty  hair  combed  down 
from  broad  partings — the  continuous  rubbing  with 
the  cap  border  wore  it  so —  ^ 

How  did  most  of  the  applicants  come  ? 

The  Margaret  School  was  the  preparatory  insti- 
tution for  the  Motherhouse.  Fourteen-year-old  girls 
came  to  it  from  the  common  schools  and  were 
then  during  four  years    prepared  for  the    deaconess 

1  Op.  cit.,  p.  72. 


52  A  History  of  Nursing 

calling.  The  world  and  humankind  and  the  great 
dynamic  forces  outside  were  unknown  to  them,  and 
there  was  for  them  no  sacrifice  of  social  ties.  In- 
stead, for  most  of  them  their  importance  in  the  social 
scale  rose  when  they  donned  the  deaconess  dress. 
The  Sisters'  cap  was  their  goal  through  all  their 
young  years,  and  when  they  received  it  they  were 
so  delighted  that  they  would  not  have  understood 
a  suggestion  that  they  had  anything  more  to  wish 
for.  Good,  earnest,  cheerful  maidens  were  they, 
full  of  loyalty  and  zeal  for  their  work,  full  of  reverence 
for  the  house.  Scarcely  one  of  them  would,  in  the 
world,  have  been  called  an  educated  yoimg  woman.  ^ 

Gabriele  had  at  the  outset  attributed  the  scanty 
pin-money  to  the  necessity  for  economy,  and,  her- 
self financially  independent,  had  never  faced  the 
economic  question,  until  it  was  brought  to  her 
one  day  by  hearing  the  teaching  Sister  speak 
belittlingly  of  those  who  nursed  for  their  living. 
**  Our  Sisters,"  said  she,  '*  work  solely  for  the  love 
of  Christ — not  for  a  salary." 

Gabriele  thought  a  moment : 

Does  money  make  a  difference?  [said  she]  Do  you 
mean  that  the  love  of  mankind  and  a  salary  are 
irreconcilable?  .  .  .  Can  money  prevent  one  from 
working  in  a  spirit  of  love?  Teachers,  physicians, 
pastors,  all  take  money — ^and  no  one  reproaches  them 
for  it.  Even  without  the  payment  of  money  one 
might  still  work  without  love.  .  .  .  ^ 

»  Op.  cit.,  p.  77. 

2  Op.  cit.,  p.  92.  On  this  point  Miss  Nightingale  said:  "It 
appears  to  be  the  most  futile  of  all  distinctions  to  classify  as 


Kaiserswerth  and  the  Deaconess     53 

The  pastor's  classes  were  painful  occasions, 
for  the  pastor  did  not  know  how  to  teach,  and 
only  succeeded  in  intimidating  his  already  shy 
and  unready  pupils.  At  his  questions  the  pro- 
bationers shrank  into  themselves  and  appeared 
even  more  mediocre  than  they  really  were.  Then 
so  wearied  were  they  always  that,  in  spite  of 
themselves,  their  eyes  closed  in  sleep  and  their 
heads  fell  whenever  the  attention  of  the  teacher 
was  turned  from  them  for  a  moment,  until  a 
sarcastic  exclamation  wakened  them,  embarrassed 
and  self-conscious.  Gabriele  was  concerned  and 
depressed  by  these  half-hours. 

Could  the  pastor  believe  in  making  them  humble 
through  humiliations?  the  poor  things  were  already, 
with  their  work,  their  sick,  and  their  discipline, 
continuously  exercised  in  humility, — did  they  need 
crushing  to  learn  to  place  all  their  hope  in  divine 
mercy?  Could  it  be  possible  that  what  was  aimed 
at  was  the  destruction  of  individuality,  instead 
of  the  sanctification  and  development  of  the  in- 
between  'paid'  and  'unpaid'  art;  so  between  paid  and  un- 
paid nursing — to  make  into  a  test  a  circumstance  as  adventi- 
tious as  whether  the  hair  is  black  or  brown,  viz.,  whether 
people  have  private  means  or  not,  whether  they  are  obliged 
or  not  to  work  at  their  art  or  their  nursing  for  a  livelihood. 
Probably  no  person  ever  did  that  well  which  he  did  only  for 
money;  certainly  no  person  ever  did  that  well  which  he  did 
not  work  at  as  hard  as  if  he  did  it  solely  for  money.  If  by 
amateurs  in  art  or  nursing  are  meant  those  who  take  it  up 
for  play,  it  is  not  art  at  all,  it  is  not  nursing  at  all.  You  never 
yet  made  an  artist  by  paying  him  well ;  but  an  artist  ought 
to  be  well  paid." — Introd.  to  Life  of  Agnes  Jones. 


54  A  History  of  Nursing 

dividual  for  the  service  of  God  by  every  gift  and 
force  and  by  the  use  of  all  the  means  of  help  and 
culture  that  abound  in  the  world? 

She  was  terrified  at  the  boldness  of  her  own 
thoughts.  Yet  the  "womanly  simplicity"  on 
which  pastor  Lohe  had  written  a  whole  book 
seemed  to  her  like  nothing  but — stupidity. 

Finally  came  the  day  when  her  relation  with 
the  ]\Iotherhouse  came  to  an  end.  It  was  the 
hour  for  pastor  Eck's  Bible  class,  and  the  meek 
young  women  sat  before  him,  struggling  with  their 
fatigue.  A  hint  of  ironic  expression  on  the  pas- 
tor's ruddy  countenance  conveyed  a  thought, 
without  words,  that  made  them  dimly  conscious 
of  being  foolish,  stupid,  uninformed.  To-day  he 
spoke  especially  of  the  requirements  of  the 
deaconess  calling.  "  Examine  yourselves  [said 
he]  to  see  whether  you  bring  with  you  a  flexible 
spirit,  out  of  which  a  yet  higher  may  be  moulded ; 
set  natures,  that  resist  modification,  fit  ill  to  the 
service." 

Gabriele  wondered  whether  by  "modification" 
he  meant  the  crushing  of  personality  and  the 
grinding  in  the  wheel  of  toil,  and  w^hether  that 
was  a  means  of  attaining  complete  domination. 
Of  learning  he  said  that  it  dared  never  be  sought 
for  its  own  sake,  as  it  then  nourished  pride;  that 
"  the  greatest  happiness  of  the  work  lay  in  obe- 
dience," and  he  then  drew  a  picture  of  the  ideal 
deaconess.  She  sparkled  with  the  diamonds  of 
every   imaginable   virtue,    including   loftiness    of 


Kaiserswerth  and  the  Deaconess     55 

thought,  down  to  the  smallest  and  finest.  That 
was  what  deaconesses  must  and  should  be;  then 
followed  what  they  must  not  be: 

"Be  not  only  humble — no — love  humiliation, 
and  take  no  offence  therefrom.  Can  you  quote 
a  verse,  Sister  Lisbeth  ?" 

"  For  God  resisteth  the  proud,  and  giveth  grace 
to  the  humble."  "Where  is  it  found?"  She 
gave  the  place.  If  any  one  approached  to  this 
ideal,  it  was  Sister  Lisbeth,  and  yet  she  always 
seemed  to  inspire  a  certain  feeling  of  vexation  in 
the  pastor. 

"  But  it  is  also  possible  to  fall  into  a  pride  of  hu- 
mility, some  have  boasted  of  their  humility — beware 
of  this.  Egotism  is  sinful,  and  even  the  craving  for 
enjoyment  is  so.  Naturally  I  speak  of  spiritual 
enjoyment,  for  you  have  separated  yoiirselves  from 
that  of  the  world,  .  .  .  Friendships  and  family  ties 
conceal  dangers  also — I  have  warned  you  against 
these,  and  in  this  connection  I  may  mention  letter- 
writing.  Seek  not  after  novelties  and  complain  not. 
.  .  .  Read  the  paragraph  on  page  38,  'On  Dressing'." 

Sister  Lisbeth  stood  up  and  read  in  reveren- 
tial tones: 

"As  a  Christian  sanctifies  everything  through 
prayer  and  the  word  of  God,  why  shall  not  a  deaconess 
make  dressing  also  a  time  of  holiness?  To  this  end 
I  recommend  the  following  prayers.  In  the  bath: 
*Wash  me  well  from  my  misdeeds  and  cleanse  me 
from   my  sins. '     In   putting  on  the  clothing :    '  Our 


56  A  History  of  Nursing 

righteousness  is  like  a  soiled  garment.  But  he  who 
conquers  shall  be  clothed  in  white  raiment. '  In 
tying  on  the  apron:  'Who  will  serve  me,  let  him 
follow  me. '  In  putting  on  the  cap :  *  Thou,  Lord, 
blessest  the  righteous  and  crownest  him  with  mercy.'  " 

Gabriele  looked  at  the  thin,  unworldly  face  of 
the  grey-haired  probationer,  and  then  at  the  morn- 
ing dress  of  the  pastor,  and  wondered,  doubting, 
whether  he  followed  a  like  programme.  He 
continued : 

"What  I  say  now  I  do  not  make  a  matter  of  con- 
science,— it  is  only  my  advice.  Order  is  also  whole- 
some for  the  soul.  Once  a  day  a  deaconess  should 
humbly  examine  herself — preferably  toward  evening. 
Once — better  in  the  course  of  the  forenoon — bring 
God  a  thank-offering  for  His  mercies;  once — perhaps 
about  three  o'clock — reflect  on  the  hour  of  death. 
It  is  also  advisable  often  to  practise  a  prayerful 
exercise  of  faith  and  hatred  of  sin.  .  .  .  Finally 
I  recommend  satisfying  reading ;  not  only  the  word  of 
God,  and  not  by  any  means  the  flood  of  Christian 
tales  which  enfeeble  one  and  suggest  a  love  of  pleasure, 
but  the  reading  of  our  old  ascetics. 

"Exercise  yourselves  daily  in  obedience,  in  humility, 
and  in  submission  both  of  body  and  soul.  Our  blessed 
father  Lohe  said:  'You  shall  practise  an  obedience 
that  shames  the  authorities.  Your  joy  shall  be  more 
and  more  in  lowliness,  in  unpretentiousness,  and  in 
meekness. " 

He  then  turned  to  Sister  Gabriele  and  asked 
her  for  an  appropriate  verse,  and  she,  overborne 
by  a  rising  tide  of  rebellion  and  dissent,  forget- 


Kaiserswerth  and  the  Deaconess     57 

ting  herself  and  all  around,  arose  and  in  a 
strange  voice  said:  "Woe  unto  you,  Scribes  and 
Pharisees,  hypocrites!"  .  .  .  "For  they  bind 
heavy  burdens  and  grievous  to  be  borne,  and  lay 
them  on  men's  shoulders ;  but  they  themselves  will 
not  move  them  with  one  of  their  fingers";  and 
again:  "Woe  unto  you  .  .  .  for  ye  lade  men 
with  burdens  grievous  to  be  borne,  and  ye  your- 
selves touch  not  the  burdens  with  one  of  your 
fingers."     They  are  found  in  Matthew  and  Luke. 

It  was  like  the  breaking  of  a  bomb,  and  pale 
horror  sat  upon  the  faces  of  the  frightened  Sisters. 

After  this  scene  Gabriele's  further  continuance 
in  the  sisterhood  was  naturally  not  to  be  thought 
of,  even  had  she  herself  not  eagerly  welcomed  the 
regained  freedom.  Later,  in  the  pastor's  study, 
he  required  her  to  explain  herself. 

"Now  you  shall  tell  me  what  you  meant  by  your 
extraordinary  words.  Literally,  they  seem  to  mean 
that  I  do  not  myself  do  what  I  demand  from  others? " 
She  nodded.  "But  I  did  not  mean  you  especially, 
but  the  principle. " 

"Indeed.  So  you  spoke  with  intention  and  hold 
to  your  words.  .  .  .  What,  exactly,  did  you  mean  by 
speaking   so   audaciously  before  the  class?     Well?" 

"I  meant  the  double  standard  by  which  you,  but 
not  you  only,  measure  yourself  and  the  Sisterhood. " 

"Then  I  must  first  point  out  to  you,  that  the 
authority  is  derived  from  God,  and  is  supported  by 
the  Scriptures.  Leaders  and  doers — ^both — are  nec- 
essary in  every  sphere  of  work ;  .  .  .  where  you  have 


58  A  History  of  Nursing 

labour  of  hand  or  foot  I  have  that  of  the  brain. 
My  responsibiHty  is  much  greater  than  yours.  My 
work  is  quite  different — therefore  my  preparation 
and  my  mode  of  life  must  be  different.  You 
cannot    compare  the  two." 

"That  is  just  what  I  mean — that  difference.  .  .  . 
You  speak  now  of  work,  but  in  class  you  speak  of 
renunciation,  of  self-denial,  of  resignation.  We  are 
to  be  holier  than  you — the  clergy." 

The  pastor  sprang  up  and  resented  this  inde- 
pendent speech,  and  reminded  Gabriele  of  the 
authority  of  the  captain  of  a  ship. 

"But  that  is  different,"  said  she,  "for  he  has  gone 
through  every  stage  of  the  sailor's  work.  He  knows 
exactly  what  he  commands.  But  you,  Pastor  Eck, 
have  never  had  any  experience  of  what  you  make 
binding  on  us.   .   .   . 

"You  demand  the  very  highest  of  us,  even  to  our 
most  secret  thoughts  and  most  intimate  feelings — 
an  unnatural  strength — and  at  the  same  time  you 
close  the  source  of  this  strength  to  us.  Strength  is 
life.  You  demand  from  us,  in  the  samic  breath,  both 
a  highly  concentrated  life,  and  the  denial  of  life. 
You  ask  what  is  impossible."  .  .  . 

"The  source  of  strength  is  the  holy  Gospel."  .  .  . 
said  Pastor  Eck. 

"  Truly,  I  have  never  been  so  little  able  to  read  it, 
as  here.  If  it  is  true  that  'man  lives  not  by  bread 
alone,  but  also  by  the  word, '  it  is  also  true  that  he 
lives  not  by  the  word  alone,  but  by  bread — both  are 
essential.  .  .  .  Our  heavenly  Father  gives  us  man; 
pleasures,  and  it  is  His  will  that  we  shall  ask  for  their 


I        Kaisersvverth  and  the  Deaconess     59 

Much  is  bestowed  upon  us  for  the  animation  and 
elevation  of  our  feeUngs  and  our  intellect — for  we 
also  work  with  both  of  these,  not  only  with  hand 
and  foot — ^for  refreshment  and  exercise,  for  enrich- 
ment and  development,  such  as  you  prize  and  know 
how  to  use,  such  as  youconsider  your  matter-of-course 
right,  even  necessity.  The  pleasures  of  nature,  of 
art,  the  cultivation  of  the  intellect,  noble  literature, 
family,  friendship,  and  congenial  society — these  are 
the  additional  springs  of  strength  that  we  also  need 
to  enjoy  in  moderation.  Without  them  our  calling 
is  a  continuous  out-giving  without  in- taking.  But 
we  must  give  up  all  that — your  will  and  the  over- 
work crushes  it.  And,  instead,  obedience  shall  be 
the  highest  joy  of  our  calling,  and  to  be  despised  a 
pleasure.  Do  you  not  call  that  laying  unendurable 
burdens?" 

Pastor  Eck  seemed  somewhat  impressed;  but 
defended  himself  by  the  argument  that  most  of 
the  Sisters  did  not  feel  in  this  way;  that  Gabriele 
possessed  a  strong  mind ,  which  they  had  not ;  that 
the  majority  of  women  desired  to  be  led  and  were 
not  capable  of  original  thinking  and  doing;  that 
in  their  ardent  love  of  God  they  were  not  conscious 
of  self-sacrifice — but  Gabriele  interrupted  him: 

"  Of  being  sacrificed.  .  .  .  They  all  suffer — all  the 
Sisters"  said  she,  "  from  the  mental  starvation  that  is 
directly  apportioned  to  them.  If  there  are  perhaps 
those  who  do  not,  it  is  because  their  subjection  is  com- 
plete, or — because  there  was  nothing  in  them  to  starve. 
We  have  the  protection  of  the  sixth  commandment — 
Thou  shalt  not  kill.    Oh,  I  know  very  well  hunger  is 


6o  A  History  of  Nursing 

a  means  of  discipline — a  means  of  gaining  mastery 
over  the  mind.  "^ 

Gabriele  left  the  deaconess  work  and  studied 
medicine. 

The  story  is  no  imaginary  one,  but  taken  from 
the  life.  The  intellectual  poverty  (and  not  that 
only,  for  poverty  might  be  remedied,)  and  the 
restrictions  on  freedom  of  thought  in  the  deaconess' 
calling  go  hand  in  hand  with  the  economic  de- 
pendency and  the  social  bareness  of  the  life,  and 
all  are  out  of  touch  with  the  progress  of  the  present 
century. 

Those  women  who  first  renounced  the  claims 
of  the  Motherhouses  on  grounds  similar  to  Ga- 
briele's,  and  who  then  endeavoured  to  make  a 
self-supporting  occupation  of  their  calling  as 
nurses,  had  a  hard  and  bitter  struggle  against 
prejudice,  but  nevertheless  the  exodus  of  the 
least  submissive  and  meek  began  and  still  con- 
tinues. The  basis  of  all  resentment  against  them 
was  that  women  who  had  for  centuries  worked 
and  slaved  for  a  bare  livelihood  should  now  cease 
to  be  satisfied  with  so  doing.  Xot  easily  would 
charitable  institutions  and  the  Church  give  up 
their  tmpaid  workers,  and  the  assertion  of  a 
right  to  the  earnings  of  one's  labour  was  character- 
ised as  godless,  sordid,  and  debasing. 

As  the  deaconess  organisation  was  in  its  first 
development  a  great  step  forward,  it  has  proved 

^  Op.  cit.,  pp.   274-286. 


Kaiserswerth  and  the  Deaconess     61 

to  be  not  the  final,  but  one  of  a  number  of  steps 
or  phases  of  social  and  of  nursing  progress.  It 
is  still  active  and  strong,  holds  a  definite  and  im- 
portant place  in  church  and  mission  work,  con- 
ducts a  vast  deal  of  beneficent  institutional  work, 
and  transplants  its  branches  further. 

It  seems  probable  that,  like  the  Sister  of  Charity, 
the  deaconess  will  gradually  count  for  less  and 
less  in  nursing  proper,  while  she  will  continue  to 
be  skilled,  valuable,  and  active  on  other  lines  of 
service. 

In  Germany,  the  home  of  the  Motherhouse, 
further  and  more  recent  lines  of  nursing  progress 
have  been  successively  marked  by  the  Red  Cross 
associations ;  by  the  large  city  schools  for  nurses, 
arranged  upon  the  English  pattern;  by  the  Dia- 
konie  Verein;  and  lastly  by  the  organisation  of 
"  Free  "  Sisters  which,  with  the  opening  of  modern 
training  schools  in  the  large  new  hospitals,  speaks 
the  latest  word  in  nursing  evolution  from  monas- 
ticism  to  voluntary  self-government  after  training, 
and  a  progressive  educational  standard.^ 

•  The  modern  nursing  movement  in  Germany,  as  well  as 
that  of  other  European  countries,  will  be  taken  up  in  another 
volume. 


CHAPTER  11 

PRE-XIGHTIXGALE  TIMES 

FROM  the  time  of  the  dissolution  of  the 
monasteries  under  Henry  VHI.  there  had 
been  occasional  protests  over  the  lack  of  any 
career  for  unmarried  women.  Fuller,  the  his- 
torian, would  have  been  glad  if  such  feminine 
foundations  had  continued — "good  shee-schools " 
but  without  vows.  The  subject  had  received  mxuch 
attention  in  the  early  part  of  the  nineteenth 
century.  I\Iore  than  thirty  years  before  Kaisers- 
werth  was  founded,  Dr.  Gooch,  a  physician  and 
philanthropist,  had  been  greatly  impressed  by 
what  he  had  seen  of  the  nursing  of  the  Beguines 
and  Augustinian  Sisters  in  the  hospitals  of  the 
Netherlands,  and  by  what  he  heard  from  the 
physicians  there  of  their  excellent  qualities  and 
devotion.  He  corresponded  with  Southey  on 
the  subject,  and  Southey  discussed  it  in  the  Col- 
loquies: "  Where  is  the  woman  who  shall  be 
the  Clara  or  the  Teresa  of  Protestant  England, 
labouring  for  the  certain  benefit  of  her  sex  with 
their  ardour,  but  without  their  delusion  or  fatal 
superstition,    which   have    entailed    such   misery 

62 


Pre-Nightingale  Times  63 

upon  thousands !"i  Southeyhad  hopes  2  (says  Mrs. 
Jameson)  that  Mrs.  Opie  would  do  for  the 
hospitals  what  Mrs.  Fry  had  done  for  the  prisons. 
He  also  looked  to  the  Quakers  as  being  more 
likely  than  the  Church  of  England  to  found  an 
order  of  Protestant  Sisters  of  Charity.  Sir 
Thomas  More  and  Montesinos  discuss  a  Gynasceum 
— a  college  rather  than  a  convent,  for  the  educa- 
tion and  training  of  women  for  useful  lives. 

Why,  then,  have  you  no  Beguines,  no  Sisters  of 
Charity?  Why,  in  the  most  needful,  the  most  merci- 
ful form  that  charity  can  take,  have  you  not  yet 
followed  the  example  of  the  French  and  the  Nether- 
lands? No  Vincent  de  Paul  has  been  heard  in  your 
pulpits;  no  Louise  le  Gras  has  appeared  among  the 
daughters  of  Great  Britain!  Piety  has  found  its 
way  into  yotir  prisons;  your  hospitals  are  imploring 
it  in  vain;  nothing  is  wanting  in  them  but  religious 
charity ;  and  oh !  what  a  want  is  that !  and  how  differ- 
ent would  be  the  moral  effect  which  these  medical 
schools  produce  upon  the  pupils  educated  there,  if 
this  lamentable  deficiency  were  supplied.  I  know 
not  whether  they  or  the  patients  suffer  most  from 
its  absence.  ...  A  school  of  medicine  ought  to  be 
also  a  school  of  Christian  humanity.  ...  It  is  not 
to  the  hospitals  alone  that  this  blessed  spirit  of 
charity  might  be  directed;  while  it  reformed  those 
establishments  by  its  presence,  it  would  lessen  the 
pressure  upon  them  by  seeking  out  the  sick,  and 
attending  them  in  their  own  habitations.^ 

>  Colloquies,  p.  214,  vol.  ii. 

2  Sisters  of  Charity  (London,  1855),  p.  92. 

3  Colloquies y  ii.,  p.  228. 


64  A  History  of  Nursing 

An  anonymous  article,  "  Protestant  Sisters  of 
Charity  "  (believed  to  have  been  written  by  Dr. 
Gooch),  had  appeared  in  Blackwood's  Magazine 
in  December,  1825,  and  a  year  later  a  pamphlet 
appeared  under  the  same  title  containing  a  "Let- 
ter" addressed  to  the  Bishop  of  London.  Both  of 
these  articles  urged  the  formation  of  an  order 
of  women  devoted  to  nursing  and  good  works, 
on  the  pattern  of  the  Sisters  of  Charity,  and  some 
efforts  were  made  to  induce  the  Established 
Church  to  experiment  with  this  plan,  but  without 
success.^  There  was  then  no  inkling  of  an  idea 
that  refined  and  conscientious  nursing  could  be 
thought  of  outside  of  the  bands  of  a  religious 
sisterhood,  and  so  lacking  was  that  time  in  a 
rational  humanity,  that  the  idea  would  without 
a  doubt  have  sounded  preposterous.  The  writer 
in  Blackii'ood's  said:  "They  [the  nurses] should  be 
animated  with  religion ;  science  and  mere  humanity 
cannot  be  relied  on.  .  .  .  Let  all  serious  Christians 
join,  and  found  an  order  of  wom.en  like  the  Sisters 
of  Charity  in  Catholic  coimtries."  Other  letters 
followed,  and  there  was  a  revival  of  the  history 
of  the  Beguines  and  Sisters  of  Charity.  Dr. 
Gooch  also  urged  his  plan  for  the  reformation  of 
ntirsing  upon  his  professional  brethren,  in  the 
London  Medical  Gazette,  over  the  signature  "A 
Coimtry  Surgeon."  2  In  this  paper  he  described 
some  nursing  experiences  of  his  own  in  hospital 

»  Appendix  of  Colloquies,  ii.,  p.  349. 

2  Q*oted  in  Colloquies,  Appendix,  vol.  ii.,  p.  343. 


Pre-Nightingale  Times  65 

practice.  He  wrote  in  an  urbane,  persuasive  style, 
evidently  possessed  a  nature  of  great  sympathy 
and  tenderness,  and  had  acquired  nursing  skill 
of  a  high  order.  He  would  select  (he  said)  tvvo  or 
three  women  at  a  time  and  place  them  in  a  hospital 
under  some  clear-headed,  practical  physician 
who  should  take  them  from  bed  to  bed,  explaining 
to  them  the  signs  by  which  he  is  guided  in  his  reme- 
dies; why  he  gives  opium,  and  why  he  draws 
blood;  ...  he  would  assist  their  memories  by 
frequent  examinations,  and  when  they  had  ac^ 
quired  a  readiness  in  detecting  all  ordinary  dis- 
eases, in  selecting  the  guiding  symptoms,  and  in 
the  use  of  a  short  list  of  remedies,  he  would  place 
them  in  the  midst  of  some  country  district,  main- 
tain them  partly  from  charitable  funds  and  partly 
from  the  parish,  and  he  believed  that  a  few  cures 
would  be  followed  by  medical  reputation  and 
that  the  villages  would  bless  the  day  of  their 
arrival. 

But  this  was  not  the  way  that  Dr.  Gooch  had 
acquired  his  ovvn  skill  in  nursing,  though  he  may 
have  learned  his  medicine  by  some  such  method, 
nor  does  he  seem  to  have  thought  of  this,  when 
he  tells  how  he  learned  to  manage  a  patient  with 
a  frightful  bedsore.  It  seems  actually  to  have 
been  his  intention  to  create  an  order  of  medical 
practitioners,  for  he  says  further: 

It  may  be  objected  that  women  with  such  an  edu- 
cation would    form  a  bad  substitute  for  a  scientific 

VOL.   II. 5. 


66  A  History  of  Nursing 

medical  attendant.  Be  it  remembered,  however,  that 
the  choice  is  not  between  such  women  and  pro- 
fessional or  perfect  physicians  and  surgeons,  but  be- 
tween such  women  and  the  ordinary  run  of  country 
apothecaries,  the  latter  labouring  under  the  additional 
disadvantage  of  wanting  time  for  the  application  of 
what  skill  they  have. 

In  his  article  in   Blackivood's  he  says    again: 

Let  them  receive  not  a  technical  and  scientific  but 
a  practical  medical  education:  let  books  be  framed 
for  them,  containing  the  essential  rules  of  practise;  ^ 
let  them  be  distributed  in  country  parishes  and  be 
maintained  by  the  parish  allowance  which  now  goes 
to  the  parish  surgeon,  who  should  be  resorted  to  only 
in  difficult  cases;  let  them  be  examined  every  half- 
year  by  competent  physicians,  about  the  state  of 
their  medical  knowledge,  and  I  fearlessly  predict  that 
my  friend  [the  country  clergyman]  will  no  longer 
complain  that  his  sick  flock  suffers  from  medical 
neglect. 

Thus  medical  reformers  and  philanthropists 
advocated  the  creation  of  a  nursing  staff  taught 
after  the  system  of  medical  students,  yet  no  one 
thought  to  ask,  if  this  manner  of  teaching  made 
nurses,  why  were  not  the  medical  students  nurses? 

There  were  others,  no  longer  known  by  name, 
who  had  a  more  correct  idea  of  the  solution  of  the 
problem.  A  writer  in  the  Christian  Observer^ 
in  an  article  published  in  1820,  said: 

'  The  italics  are  ours. 


Pre-Nightingale  Times  67 

I  am  not,  however,  aware  that  a  school  for  nurseff 
forms  a  regular  part  of  hospital  discipline,  though  it 
appears  well  worthy  of  doing  so,  and  would  be  an 
incalculable  benefit  to  the  community.  I  would 
propose  that  in  every  infirmary  any  respectable  fe- 
male who  wished  to  learn  the  art  of  nursing  should 
be  apprenticed,  if  I  may  so  express  it,  for  a  certain 
term,  say  six  or  twelve  months,  and  receive  a  course 
of  theoretical  and  practical  instruction  in  her  in- 
tended profession,  and  if  found  competent,  should  be 
entitled  to  a  certificate  of  her  ability  and  moral 
deportment. 

Among  the  anonymous  answers  to  the  **  Inquiry" 
already  spoken  of  were  several  that  went  to  the 
point.     Said  one: 

The  best  way  to  effect  your  object  would  be  to 
form  an  institution  in  which  women  would  be  trained 
to  become  nurses.  None  of  the  institutions  now 
existing  answer  this  purpose,  as  they  train  for  private 
families  only.  The  institution  should  be  for  hospitals 
only  .  .  .  and  sufficiently  near  to  some  hospital  for 
the  women  to  learn  the  art  of  nursing. 

Another  wrote : 

It  has  occurred  to  me  that  a  training  institution 
for  nurses  might  be  a  practicable  and  useful  improve- 
ment. It  might  be  a  model  hospital,  where  the 
business  of  nursing  might  be  taught,  and  religious 
training  added. 

To  these  opinions  was  added  that  of  Dr.  Chatto, 
of  St.  Bartholomew's  Hospital,  who,  in  1835,  writ- 
ing in  the  London  Medical  Gazette,  made  a  plea 


68  A  History  of  Nursing 

for  better  niirsing  and  urged  that  the  large  hos- 
pitals were  well  adapted  as  training  fields  and 
that  they  should  be  utilised  for  providing  good 
nurses.  He  criticised  the  bad  methods  of  the 
time  severely  and  attributed  the  general  intem- 
perance of  nurses  to  their  desire  to  stimulate 
themselves  when  exhausted. 

Both  touching  and  extraordinary  was  a  proposi- 
tion set  forth  in  1847  ^Y  Sir  Edward  Parry  of  the 
Royal  Navy  and  superintendent  of  Haslar  hos- 
pital.^ He  had  learned  of  the  success  of  the  Kai- 
serswerth  experiment  in  training  deaconesses,  and 
after  delineating  in  noble  language  the  ideal 
nurse,  womanly  and  gentle,  he  describes  his  and 
his  officers'  wish  that  the  naval  hospital  serv^ice 
might  be  improved  by  following  the  Kaisers- 
werth  example.  He  cannot  doubt  (he  adds)  that 
many  of  his  countrywomen  will  be  ready  to  devote 
themselves  to  the  "work  and  labour  of  love"  and 
suggests  as  his  plan : 

1.  To  endeavour  to  engage  in  the  first  instance 
the  services  of  three  or  four  Christian  women,  be- 
tween the  ages  of  thirty  and  fifty,  who,  upon  the 
principles  and  conditions  adopted  at  Kaiserswerth, 
are  willing  to  devote  themselves  to  this  work  at  Has- 
lar Hospital. 

2.  These  persons,  when  engaged,  to  be  trained 
for  six  months  at  the  German  hospital  at  Dalston, 
according  to  the  system  pursued  at  Kaiserswerth 
(but  he  forgot  that  at    Kaiserswerth  the  probation 

1  Hospitals  ayid  Sisterhoods,  1855,  pp.  38-41, 


Pre-Nightingale  Times  69 

time  alone  was  often  more  than  six  months),  or 
if  circumstances  permit,  to  be  placed  at  Kaisers- 
werth  for  their  training. 

3.  Their  training  being  completed,  the  nurses 
to  be  admitted  to  Haslar  Hospital,  where  they  will 
receive  no  pecuniary  allowance,  but  a  comfortable 
home,  neat,  and  respectable  lothing,  and  a  suffi- 
cient maintenance.  Their  duties  will  be  arduous 
and  self-denying,  and  they  will  meet  with  much  to 
exercise  their  Christian  patience  and  forbearance, 
but  they  will  receive  encouragement  and  support 
from  the  captain-superintendent  and  the  other  officers. 

A  call  for  contributions  followed,  in  the  hope 
that  a  successful  experiment  might  be  imitated 
throughout  the  kingdom.  It  was  signed  William 
Edward  Parry,  Captain-Superintendent,  Haslar 
Hospital,  1847.  Later  he  wrote  (sadly,  one  can- 
not doubt) :  "  For  this  plan  we  did  not  get  one 
offer  to  do  this  service — though  hundreds  of  my 
paper  were  circulated  far  and  wide."  Good, 
brave,  and  simple-hearted  sailor,  with  a  genuine 
vision  reflecting  only  nobly  on  his  own  character, 
his  was  the  same  error,  ever  old  and  ever  new, 
of  thinking  that  a  work  wrought  out  of  life-long 
effort  and  the  souls  of  rare  characters  like  the 
Fliedners,  or  Louise  le  Gras  and  Vincent  de  Paul, 
can  be  copied  at  will  and  reproduced  anywhere 
on  demand  in  the  short  space  of  six  months. 

The  first  practical  demonstration  of  training 
nurses  in  England  did,  however,  own  a  spiritual 
bond  with  Kaisers werth.  It  was  that  given  by 
Mrs.  Fry. 


70  A  History  of  Nursing 

Elizabeth  Gumey,^  born  on  May  21,  1780,  and 
early  married  to  Joseph  Fry,  possessed  a  nature 
of  rare  beauty  and  goodness,  which  impressed 
itself  with  extraordinary  strength  upon  her  con- 
temporaries. She  belonged  to  an  eminently 
liberal  and  progressive  Quaker  family  and  circle 
— reformers  one  and  all — and  she,  in  her  beautiful 
and  gracious  presence,  typified  mercy,  benignity, 
and  practical  wisdom.  She  began  her  reform 
work  coincidently  with  her  married  life  by  fol- 
lowing home  a  beggar  woman  carrying  a  half- 
frozen  child.  The  woman,  wishing  to  beg  but 
not  to  be  visited,  tried  in  vain  to  evade  the  brave 
young  woman,  who  succeeded  in  tracing  her  and 
in  unearthing  a  shocking  trade  in  starved  infants. 
In  her  country  home  she  laboured  incessantly  in 
the  cottages  of  the  poor — hers  was  friendly 
visiting  work  in  its  most  loving  and  intelligent 
form.  She  was  an  ardent  believer  in  vaccination, 
and  performed  the  operation  skilfully  herself, 
making  frequent  rounds  of  inspection  for  this 
purpose  in  villages  near  by,  with  the  result 
(unusual  at  that  day)  that  smallpox  was  almost 
non-existent  in  the  regions  round.  Mrs.  Fry's 
special  life-work,  like  that  of  Howard,  was  the 
amelioration  of  the  lot  of  prisoners  and  the 
humanisation  of  prison  conditions.  She  began 
in  18 13  her  famed  work  in  the  Newgate  prison, 

^TJte  Life  of  Elizabeth  Fry,  by  Susanna  Corder,  1884  ;  and 
A  Memoir  of  the  Life  of  Elizabeth  Fry,  in  2  vols.  By  her 
Daughter,  1847. 


i 


Pre-Nightingale  Times  71 

led  to  it  by  the  reports  of  Quaker  friends  who 
had  been  in  the  habit  of  visiting  there.  Conditions 
were  so  distressing  that  it  might  have  been  thought 
that  Howard's  Hfe  had  been  spent  in  vain.  The 
description  of  the  female  side  of  Newgate  pictures 
a  hell — which  indeed  it  was: 

Three  hundred  women,  with  their  children,  in  the 
same  room,  in  rags  and  dirt,  destitute  of  sufficient 
clothing  (no  provision  being  made  for  this),  sleeping 
without  bedding  on  the  floor,  at  one  end  of  which 
the  boards  were  raised  to  form  a  sort  of  pillow,  .  .  . 
here  they  lived,  cooked,  and  washed.  Howard  and 
his  humane  exertions  appeared  to  have  been  forgotten. 
Dungeons,  damp,  close,  and  narrow  cells  often 
formed  the  common  prisons  of  offenders  of  either 
sex  and  of  all  grades  of  crime.  The  danger  of  escape 
was  guarded  against  by  heavy  iron  fetters,  dirt  and 
disease  abounded;  these  evils  were  magnified  by  the 
crowded  state  of  the  prisons.   .  .   . 

The  death  penalty  was  still  fixed  for  trifling 
offences.     A  note  from  Mrs.  Fry's  journal  reads: 

Beside  this  poor  young  woman  there  are  also  six 
men  to  be  hanged,  one  of. whom  has  a  wife  near  her 
confinement,  who  is  also  condemned,  and  seven 
young  children.  Since  the  awful  report  came  down 
he  has  been  quite  mad  from  horror  of  mind  and  has 
bitten  the  turnkey.  A  strait-jacket  could  not  keep 
him  within  bounds.  ^ 

In  this  place  Mrs.  Fry  and  her  friends  estab- 

»  Life  of  Mrs.  Fry,  by  S.  Corder,  p.  243. 


72  A  History  of  Nursing 

lished  a  school  for  the  children  and  started  sewing 
classes,  providing  material  for  work  and  food  for 
the  women.  They  helped  them  to  earn  and  save, 
and  befriended  them  upon  release.  Every  day 
for  years  there  was  some  one  of  this  circle  in  the 
prison,  and  the  change  effected,  little  short  of 
miraculous,  attracted  the  attention  of  philanthro- 
pists in  all  countries.  In  1818  Mrs.  Fry  was  called 
to  give  testimony  as  to  the  prisons  before  the 
House  of  Commons. 

On  his  visits  to  England  pastor  Fliedner  had 
learned  of  this  work  and  had  met  Mrs.  Fry,  of 
whom  he  wrote;  "  Of  all  my  contemporaries  none 
has  exercised  a  like  influence  on  my  heart  and 
life.  ...  In  January,  1824,  I  had  the  privilege  of 
witnessing  the  effects  of  her  wonder-working 
visits  among  the  miserable  prisoners  of  Newgate." 
In  1840,  on  a  trip  to  the  continent,  Mrs.  Fry  had 
visited  Kaisers werth,  to  the  great  joy  of  the  pastor 
and  his  wife.  He  wrote:  "My  happiness  may 
be  imagined  when  she  came  in  person  to  see  and 
rejoice  over  the  growing  establishment  of  Kaisers- 
werth.  She  saw  the  whole  house,  going  into 
every  room,  and  minutely  examining  every  detail." 
Mrs.  Fry's  habitual  acquaintance  with  sickness 
among  the  poor  and  her  hours  at  their  bedsides 
had  long  impressed  the  need  and  importance  of 
nursing  on  her  thoughts.  Now,  what  she  heard 
and  saw  at  Kaisers  werth  made  her  most  desirous 
of  beginning  something  of  the  kind  at  hom.e.  Her 
own  work  made  it  impossible  for  her  to  give  much 


Pre-Nightingale  Times  73 

time  to  the  project,  but  through  her  sister  and  a 
daughter  it  was  taken  up  and  brought  to  fruition.  ^ 
In  1840  an  Institute  of  Nursing  was  estabhshed 
in  Devonshire  Square,  Bishopsgate,  and  the  pupil 
nurses  were  first  called  *'  Protestant  Sisters  of 
Charity."  The  name  gave  rise  to  suspicion  and 
sectarian  prejudice  and  was  later  changed  to  that 
of  ''  Nursing  Sisters. "^  The  nurses  were  domiciled 
in  the  Home,  where,  on  the  plan  of  Kaiserswerth, 
they  were  carefully  supervised  and  mothered. 
Their  hospital  training  was  received  at  Guy's  Hos- 
pital, and  was  of  the  sort  w^hich  has  characterised 
the  beginnings  of  the  training  in  nursing  in  almost 
every  country,  namely,  what  one  might  call  hos- 
pital visiting,  for  these  pupils  had  no  organic  re- 
lation to  the  hospital,  but  went  there  daily  for  a 
short  term  of  several  m.onths  (later  lengthened  in 
accordance  with  the  rising  standard),  to  work 
under  the  untrained  nurses  of  the  wards,  and  to 
be  taught  by  the  physicians.  It  is  not  evident 
that  they  had  any  theoretical  instruction  or 
classes.  The  Sisters  were  most  carefully  chosen, 
and  we  may  vrell  believe  that  they  made  up  in 
earnestness  for  the  desultory  character  of  their 
training.  They  were  prepared  only  as  attendants 
for  private  nursing,  and  made  little,  if  any,  im- 
pression in  hospital  work.  In  the  fact  that  they 
did,  however,  have  some  experience  in  a  general 
hospital,  they  were  ahead  of  the  school  in  Phila- 
delphia, in  the  United  States,  which  at  that  same 
»  Corder's  Life,  p.  565.  ^  Ibid.,  p.   565. 


74  A  History  of  Nursing 

time  was  developing  under  the  care  of  a  group 
of  Quakers  of  that  city  for  private  nursing :  other- 
wise the  general  lines  on  which  the  tw^o  groups 
were  arranged,  the  home  training  and  serious 
spirit,  the  earnest  purpose  and  practical  good 
sense  of  the  founders,  give  these  two  early  ex- 
periments a  good  deal  of  similarity.  We 
do  not  know  that  there  was  any  relation 
between  the  English  and  the  American  early 
nursing  schools  of  the  Quakers,  but  as  Mrs. 
Fry  had  a  brother  in  Philadelphia,  it  is  not  im- 
probable. 

Naturally,  no  imitation  of  churchly  orders  would 
arise  under  the  management  of  the  Friends.  The 
extent  to  which  Mrs.  Fry  was  in  advance  of  her 
time  was  shown  by  the  coldness  in  the  attitude 
taken  by  religious  writers  toward  the  principles 
on  which  the  Nursing  Sisters  were  founded. 
While  others  insisted  on  the  necessity  for  holding 
nurses  in  the  strict  bands  of  religious  discipline, 
Mrs.  Fry  started  hers  without  bond  or  forms  of 
ceremonial,  though  the  spirit  which  animated 
their  Home  was  a  devoutly  pious  one.  Hers  was 
a  secular  order,  and  she  intended  to  create  a 
method  by  which  a  reasonable  maintenance  for 
the  nurses  would  be  combined  with  an  efficient 
and  often  gratuitous  care  of  the  sick.  The  Sisters 
were  to  be  maintained  by  the  institution  and 
were  not  permitted  to  receive  any  money  or  gifts 
They  were  to  work  in  the  spirit  of  the  Sisters  of 
Charity,  yet,  after  all,  theirs  was  a  lay  sisterhood 


Pre-Nightingale  Times  75 

and  their  training  was  only  for  nursing.  ^  For 
this  reason  Pusey,  who  was  at  this  time  interest- 
ing himself  in  projects  of  nursing  reform,  did  not 
entirely  approve  of  them,  as  their  mode  of  life 
contemplated  only  so  much  self-denial  as  was 
necessary  for  a  nurse's  work^  (even  so  much 
may  have  been  rather  more  than  the  good  divine 
quite  realised).  Miss  Stanley,  who  in  speaking 
of  them  said:  "The  English  Protestant  Sisters 
of  Charity  were  only  paid  nurses  belonging  to  a 
society  established  by  Mrs.  Fry,"  added,  "The 
further  and  higher  idea  she  did  not  live  to  estab- 
lish." 2  Even  pastor  Fliedner  was  ultimately 
disappointed  in  them,  for  he  told  Agnes  Jones, 
in  i860,  of  his  regret,  after  the  consultations  he 
had  had  with  Mrs.  Fry  about  her  nursing  work, 
to  find  it  such  a  limited  one;  he  thought  her 
nurses'  sphere  restricted,  in  comparison  to  what  it 
might  be,  and  regretted  also  that  no  attempt 
was  made  to  improve  them  by  mental  culture.* 

Mrs.  Fry  did  not  live  long  enough  to  see  more 
than  the  beginning  of  her  nursing  reformation. 
She  died  in  1845,  2,nd  her  Life,  as  it  was  written, 
makes  only  slight  mention  of  the  Nursing  In- 
stitute and  throws  no  light  upon  its  details. 
Nor    does    the    hospital     history    mention    Mrs. 

»  Memoirs  of  Agnes  E.  Jones,  1885,  by  her  Sister,  p.  383. 

2  Life  of  E.  B.  Pusey,  by  Canon  Liddon,  1894,  vol.  iii.,  chap- 
ter on  "  Early  Days  of  Anglican  Sisterhoods." 

3  Hospitals  and  Sisterhoods,  p.  59. 

*  Memoirs  of  Agnes  E.  Jones,  p.   135. 


76  A  History  of  Nursing 

Fry's  nurses.^  By  1857  ninety  nurses  had  been 
trained  there,  all  of  whom  were  engaged  in  private 
duty.  The  Institute  is  still  in  existence  as  a  very 
successful  and  well-managed  training  institution 
for  private  nurses. 

The  next  wave  of  effort  rose  in  the  Established 
Church  and  brought  into  existence  much  interest- 
ing and  historically  significant  nursing  organi- 
sation and  training,  for  the  early  Anglican 
sisterhoods  experimented  in  many  forms  of  social 
service,  including  visiting  nursing;  they  entered 
hospitals,  gave  a  demonstration  of  refined  and 
educated  gentlewomen  taking  up  the  despised 
duties  of  the  nurse,  and  some  of  their  members 
were  pioneers  not  only  in  the  humbler  but  also  in 
the  higher  fields  of  hospital  management  and 
ward  guidance.  They  had  some  well  prepared 
women  ready  to  go  to  the  Crimea  with  Miss 
Nightingale,  and  from  one  of  their  groups  came 
the  Sister  who  later  successfully  organised  the 
Bellevue  school  of  nursing  in  the  United  States. 

Dr.  Pusey  wrote  to  Keble  in  1839  of  his  con- 
viction that  it  was  necessary  to  have  Sisters  of 
Charity  and  employ  them  as  nurses  in  hospitals 
and  lunatic  asylums  "in  which  last  Christian 
nursing  is  so  sadly  missed . ' '  He  also  corresponded 
with  a  physician.  Dr.  Greenhill,  on  the  same  sub- 
ject, and,  through  him,  obtained  a  copy  of  the 
rules  of  the  Augustinian  Sisters  and  the  Sisters 

i  Biographical  History  of  Guy's  Hospital,  Wilks  and 
Bettany,  LxDndon,  1892. 


Pre-Nightingale  Times  77 

of  Charity  of  Vincent  de  Paul.  The  first  sister- 
hood in  the  EngHsh  Church  arose  under  Pusey's 
guidance  in  1845.  ^^  ^^^  called  the  Park  Village 
Community,  and,  under  the  care  of  a  committee, 
was  housed  in  Regent's  Park.  Pusey  had  gone 
abroad  in  1841  to  study  French  sisterhoods  and 
nursing  orders.  But  the  leanings  of  his  mind  drew 
him  from  the  more  active  orders  of  August inians 
and  Soeurs  to  the  rule  of  St.  Francis  de  Sales'  Order 
of  the  Visitation,  from  which,  as  we  have  seen, 
active  nursing  work  had  been  displaced  by  ascetic 
regulations,  and  it  was  a  modification  of  this  rule, 
providing  for  about  four  hours  daily  of  visiting 
among  the  poor,  which  was  finally  adopted  for 
the  Park  Village  Community.  There  was  no 
training  in  nursing  provided  for,  not  even  a  course 
of  walking  the  hospitals,  but  there  was  friendly 
visiting  of  the  poor  and  sick,  at  home  and  in 
hospitals  and  workhouses,  burying  the  dead, 
Ragged  School  work,  etc.  The  members  were 
called  Sisters  of  Mercy.  Gladstone  was  among 
the  important  sympathisers  with  the  movement. 
In  1848,  Miss  Sellon  began  a  similar  work  at 
Devonport,  by  gathering  a  group  of  devoted 
women  together  for  service  among  the  poor.  The 
Bishop  of  Exeter  approved  their  labours  and 
permitted  them  to  form  an  order  of  Sisters  of 
Mercy  under  the  wing  of  the  Church.  Miss  Sellon 
and  her  Sisters  were  active  in  Bethnal  Green  and 
Plymouth,  and  later  in  the  east  end  of  London. 
Although  they  had  no  regular  training  as  nurses, 


78  A  History  of  Nursing 

they  took  every  opportunity  of  giving  service  in 
sickness,  and  in  1849,  during  an  epidemic  of 
cholera  in  Plymouth,  they  were  courageous  and 
untiring  in  seeking  out  the  sufferers,  visiting  and 
aiding  them.  That  they  then  attempted  nursing  in 
the  strict  sense  is  doubtful,  but  they  did  not  spare 
themselves  in  meeting  all  kinds  of  emergencies 
and  in  efforts  to  relieve  distress.  That  they  later 
developed  a  somewhat  systematic  preparation  for 
the  care  of  the  sick  is  evident  from  the  fact  that 
the  Superior  and  a  number  of  Sisters  accompanied 
Miss  Nightingale  to  the  Crimea.  About  this  time, 
they  had  a  hospital  at  Bristol  and  a  Nursing 
Sisters'  Home  connected  with  the  church  of 
St.  Barnabas,  Pimlico,  where  a  few  patients  were 
received  and  from  which  nurses  went  out  to  nurse 
the  poor  in  their  homes.  ^  In  1866  the  cholera 
raged  in  London,  and  Pusey  helped  to  found  a 
cholera  hospital  there.  By  this  time  there  had 
been  a  fusion  between  the  Park  Village  and  Miss 
Sellon's  communities,  and  Pusey  offered  the 
services  of  Miss  Sellon  and  her  Sisters  to  take 
charge  of  the  hospital,  which  they  did,  for  they 
had  worked  as  volunteers  through  a  number  of 
epidemics,  and  were  fearless  and  energetic. 

As  this  Sisterhood  had  developed  extremely 
high  church  tendencies,  it  had  many  enemies; 
and  attacks  were  made  upon  it  in  print,  which 
still  survive,  sounding,  it  must  be  felt,  absurdly 

»  Hospitals  and  Sisterhoods,  p.  52. 


Pre-Nightingale  Times  79 

hysterical  and  sensational.^  It  is  perhaps  true, 
however,  that  some  of  the  ceremonials  instituted 
by  Miss  Sellon  and  Dr.  Pusey  lent  themselves  easily 
to  the  ridicule  of  the  irreverent.  Nevertheless 
the  exquisitely  refining  influence  of  the  Sisters* 
atmosphere  should  not  be  forgotten  by  critics, 
for  this  must  remain  as  their  most  precious  con- 
tribution to  the  social  life  around  them.  The 
love  of  beauty,  with  the  consistent  determination 
to  bring  it  into  the  lives  of  the  people,  and  a  sensi- 
tive consideration  for  the  feelings  of  the  poor,  were 
abiding  principles  with  Miss  Sellon,  and  so  sordid 
and  hideous  appears  to  have  been  the  lot  of  the 
poor  by  whom  she  was  surrounded  that  this 
should  ever  be  remembered  of  her  gratefully. 

The  community  of  St.  John's  House,  founded 
in  1848,  was  the  first  purely  nursing  order  in  the 
Anglican  Church,  and  has  had  an  important  and 
interesting  part  in  the  development  of  English 
nursing.  Dr.  Todd,  of  King's  College  hospital, 
was  conspicuous  in  the  preliminary  movement,  as 
was  also  Mrs.  William  Morrice.^  In  a  letter  pri- 
vately circulated  in  1847,  ^^-  Todd  originally 
projected  an  establishment  for  training  nurses 
in  connection  with  King's   College  hospital,  and 

1  See  Sisterhoods  in  the  Church  of  England,  by  Margaret 
Goodman,  London,   1864. 

2  A  pamphlet  entitled:  "A  Brief  Account  of  the  Design, 
Origin,  and  Progress  of  the  Training  Institution  for  Nurses 
for  Hospitals,  Families,  and  the  Poor,"  published  by  Richard 
Clay,  in  a  report  dated  Nov.,  1850,  gives  Mrs.  Morrice  as  the 
Lady  Superintendent  at  that  date. 


8o  A  History  of  Nursing 

under  the  auspices  of  Bishop  Blomfield  and  in 
concert  with  other  friends  he  took  a  leading  part 
in  drawing  up  the  fundamental  rules  and  in  fram- 
ing the  arrangements  under  \\hich  St.  John's 
House  was  set  on  foot  in  the  following  year. 

Dr.  Bowman,  also  of  King's  College  hospital, 
was  likewise  very  active  in  working  for  nursing 
reform,  and  one  of  the  earliest  steps  in  the  founda- 
tion of  St.  John's  House  appears  to  have  been  a 
circular  letter,  of  which  no  copy  survives,  written 
by  Dr.  Bowman  to  eminent  medical  men.  The 
first  public  action,  which  was  apparently  the 
result  of  this  letter,  was  the  gathering  of  a  very 
impressive  array  of  bishops  and  clerg}',  lords, 
and  members  of  the  ro3"al  family  on  the  13th  of 
July,  1848.  At  this  meeting  the  following  pro- 
posal was  considered : 

It  is  proposed  to  establish  a  corporate  or  collegiate 
institution,  the  objects  of  which  would  be  to  maintain 
in  a  community  women  who  are  members  of  the 
Church  of  England,  who  should  receive  such  in- 
struction and  undergo  such  training  as  might  best 
fit  them  to  act  as  nurses  and  visitors  to  the  sick  and 
poor.  It  is  proposed  to  connect  the  institution  with 
some  hospital  or  hospitals,  in  which  the  women  under 
training,  or  those  who  had  been  already  educated, 
might  find  the  opportunity  of  exercising  their  calling 
or  of  acquiring  experience.  It  is  absolutely  necessary 
to  the  success  of  the  design  and  the  real  amelioration 
of  the  class  of  persons  for  whose  benefit  it  is  intended, 
that  the  proposed  establishment  should  be  a  religious 


Pre-Nightingale  Times  8i 

one,  and  that  all  connected  with  it  should  regard 
the  work  in  which  they  are  embarked  as  a  religious 
work.  ^ 

The  society  thus  formed  under  the  most  dis- 
tinguished auspices  later  issued  a  pamphlet  dealing 
more  fully  with  the  proposed  plans.  A  committee 
of  sixteen  clergymen  and  physicians,  among  whom 
were  many  noted  men  but  with  whom  no  woman 
was  associated,  was  formed  to  arrange  the  details. 

Lord  Nelson  was  warmly  interested  in  this  plan, 
and  wrote  soon  after  the  meeting  to  Dr.  Words- 
worth : 

My  dear  Dr.  Wordsworth: 

We  shall  publish  in  the  papers  as  soon  as  pos- 
sible a  meeting  of  the  Council,  having  first  found 
out  the  most  convenient  day  for  the  Bishop  of  London 
and  the  principal  members  to  attend. 

We  must  then  pass  the  formal  resolutions  as  to 
quorums,  etc.,  and  fix  four  quarterly  meetings  or 
monthly  ones,  etc.;  decide  how  to  begin  work;  state 
what  funds  will  be  sufficient  to  warrant  a  beginning; 
appoint  a  place  for  applicants;  consider  the  important 
rules,  especially  the  dietary  and  board  money,  which 
a  great  many  think  too  high  ...  fix  on  our  locality, 
etc.  All  this  should  be  done  before  the  effect  of  our 
meeting   cools,   remembering   always  that  if  we  do 

"As  St.  John's  House  has  taken  an  important  part  in 
nursing  history  we  have  quoted  freely  from  the  articles 
" St.  John's  House  in  the  Past"  in  the  St.  John's  House  News, 
beginning  in  October,  1902,  and  continued  to  date.  The 
Sister  Superior  in  granting  this  permission  desires  it  to  be 
noted  that  these  records  are  but  fragmentary. 
VOL.  n.^ — 6. 


82  A  History  of  Nursing 

not  get  a  start  soon  we  shall  be  sadly  thrown  back 
by  the  absence  from  town  of  many  members.  I 
think  the  Council  ought  to  appoint  some  five  a  Com- 
mittee to  meet  at  all  times  and  to  report  to  their 
monthly  or  quarterly  meeting,  and  I  should  be  de- 
lighted to  be  one  of  the  workers,  or  if  my  absence  from 
town  should  render  me  unfit,  I  should  be  happy  to 
assist  b}'  written  suggestions,  sending  out  circulars, 
etc. 

Do  see  if  you  can  stir  up  people  for  our  first  Council 
meeting,  for  I  am  sure  time  is  most  precious  to  us 
just  now,  lest  people's  ardour  cool  after  reading  our 
speeches,  and  check  their  charitable  feelings  by  the 
remark  "but  nothing  has  come  of  it." 

Believe  me. 

Yours  sincerely 

Nelson. 


Some  few  months  after  the  date  of  this  meeting, 
during  which  time  the  organisation  and  raising  of 
funds  was  carried  on  with  much  zeal,  the  "Training 
Institution  for  Nurses  in  Hospitals,  Families,  and  for 
the  Poor"  began  its  work,  finding  its  first  home  in 
36  Fitzroy  Square,  in  the  district  of  St.  John  the 
Evangelist,  in  St.  Pancras,  from  which  it  took  its 
name  of  St.  John's  House.  (This  was  in  the  year 
1848.)  At  this  early  period  it  derived  most  impor- 
tant help  from  the  devotion  of  Miss  Elizabeth  Frere,^ 
who  for  the  first  six  months  personally  superintended 
and    developed    all    internal    arrangements    for    the 

»  See  also  a  pamphlet  published  by  Harrison  and  Sons, 
called:  "A  Short  Account  of  the  History  and  Work  of  the 
House  and  Sisterhood  of  St.  John  the  Evangelist,"  p.  3. 


Pre-Nightingale  Times  83 

house.  Although  Mrs.  Fry  had  been  first  in  the 
field  with  her  Institute  for  Private  Nurses  in  Bishops- 
gate  (founded  in  1840),  St.  John's  House  was  the 
first  attempt  of  an  Institute  for  Nurses  on  definite 
Church  lines,  and  it  may  claim  a  distinct  position 
of  having  a  religious  foundation.  All  the  nurses 
were  members  of  the  Church  of  England,  and  were 
under  the  supervision  of  the  "Master"  of  the  House, 
who  was  to  be  a  Clergyman  in  Priest's  orders,  and 
was  to  give  definite  religious  instruction  to  the  nurses 
and  to  conduct  their  services.  The  first  Master  was 
the  Rev.  F.  W.  Twist.  Miss  Frere  acted  as  first 
Lady  Superintendent. 

The  writer  of  the  articles  quoted  from  thinks  the 
first  probationers  were  sent  to  the  Middlesex 
Hospital  for  training.  ^  An  old  letter  in  the  Nursing 
Record  said  they  were  sent  to  the  Westminster.  ^ 
It  would  seem  probable  that  a  small  group  of 
probationers  might  have  been  taken  by  each  of 
these  hospitals. 

The  Bishop  of  London  acted  as  President  of  the 
Society.  The  Master  was  to  be  either  married, 
or  a  widower,  and  the  Lady  Superintendent  was  to 
regulate,  with  the  concurrence  of  the  Master,  the 
domestic  arrangements  and  the  appointments  of 
nurses. 

There  were  to  be  three  classes  of  members: 

I.     Probationers:    these    must     be    at    least 

^St^  John's  House  League  News,  April,  1903,  p.  80. 
^  The   Nursing   Record,     London,    May   30,    1889;     letter 
signed  K.  H. 


84  A  History  of  Nursing 

eighteen  years  old  and  able  to  read  or  write  (it 
is  evident  from  this  proviso  that  this  class  was  not 
of  a  high  social  grade) ;  they  were  to  be  under 
training  two  years,  receiving  board,  lodging,  and 
laundry,  and  paying  fifteen  pounds  a  year.  At  the 
end  of  the  two  years  they  might,  if  approved, 
enter  the  second  class,  called 

2.  Nurses:  To  this  class  suitable  women 
might  also  be  admitted  without  probation  (these 
would  probably  be  from  the  class  of  educated 
or  gentlewomen)  and  all  nurses  must  remain 
at  least  five  years.  They  would  receive  board, 
lodging,  and  wages,  and  at  the  end  of  five 
years,  if  competent  and  deserving,  a  certificate. 

3.  Sisters:  these  might  either  be  residents  in 
the  Home,  paying  fifty  pounds  a  year,  or  they 
might  live  with  their  families  and  friends.  They 
must  remain  at  least  two  years,  and  were  ex- 
pected to  be  examples  to  the  other  two  classes, 
sharing  in  the  religious  and  professional  instruc- 
tion and  the  work  in  families  and  hospitals.  The 
connection  with  King's  College  hospital,  which 
lasted  until  1885,  dates  from  1849,  at  which  time 
the  first  probationers  were  sent  to  this  hospital, 
so  closely  connected  with  the  history  of  St.  John's 
House.  The  Council  meetings  were  often  held  in 
the  hospital  hall,  and  Dr.  Todd,  whose  statue 
stands  there  now,  was  always  there  to  give  advice 
and  help.  The  whole  charge  of  the  wards  was 
not  given  to  the  Institute  at  first,  but,  as  with 
Mrs.   Fry's  nurses,  the  probationers  and  nurses 


Pre-Nightingale  Times  85 

were  permitted  to  spend  some  time  daily  in  the 
wards  in  the  care  of  the  sick.^ 

It  may  be  of  interest  to  know  what  the  arrange- 
ments for  the  day,  etc.,  were  in  thosa  early  times.  A 
copy  of  the  Time-table  of  the  Master's  day  in  1849 
reads: 

"  7  :3o.     Prayers  in  Chapel  or 

**  8.00.     Service  in  St.  John's  Church. 

"  10.00.  Interview  with  the  Lady  Superintendent, 
when  all  details  about  the  House,  Nurses,  etc.,  were 
discussed  and  settled.  Instruction  to  individual 
nurses. 

"  12.00.  Instruction  for  Sisters,  Tuesday,  Thursday, 
Saturday,  on  the  Parables  of  our  Lord. 

"  1. 00.  Dine  with  inmates  (at  least  three  times  a 
week).      Shew  house  to  visitors. 

"3.00.  Instruction  for  Probationers,  Tuesday, 
Thursday,  Saturday,  on  the  Book  of  Common 
Prayer,  or  private  interviews  with  nurses,  etc. 

"  4.00.     House  Committee  (Mondays.) 

**  Office  hours:  10.00  to  1.35 — 3  to  5." 

The  Master  appears  to  have  had  charge  of  many 
household  matters  for  he  "  saw  Treloar's  man  to  meas- 
ure hall  and  staircase  for  cocoanut  matting"; 
"  arranged  with  Clay's  man  about  painting  Chapel 
window";  "  interviewed  Sarah  .  .  .  whom  I  admon- 
ished." He  sent  out  the  accounts,  saw  applicants  for 
admission,  and  in  his  diary  are  terse  comments  on 
some  of  them : 

■'  Oct.   10. — Saw  M E candidate  for   the 

situation  of  nurse ;  well  recommended  .   .  .  but  appears 

'  The  British  Magazine  gave  the  scheme  of  training  in  July. 
1848. 


86  A  History  of  Nursing 

too  diminutive  in  person  to  discharge  the  duties  of 
nurse  efficiently;  sent  to  consult  Dr.  Todd,  who  is 
of  opinion  she  may  come  for  a  fortnight  on  trial.  ..." 

"  Dec.  6. — E H applied  as  nurse,  .  .  .  but 

appears  self-conceited  and  ill-tempered.  No  room 
for  such  at  present.   .   .  . 

It  was  later  found  best  that  the  Lady  Superin- 
tendent should  be  responsible  for  many  of  the  details 
which  had  first  been  undertaken  by  the  Master,  but 
which  lay  more  in  the  province  of  the  lady  of  the 
house.  .   .   .  ^ 

When  the  crisis  of  the  Crimean  war  came,  St. 
John's  House  made  the  first  offer  of  ser\4ce. 
The  blaster  (the  Reverend  C.  P.  Shepherd)  wrote 
a  proposal  to  the  Lord  President  of  the  Institution 
(Bishop  Blomfield),  that  certain  nurses  from  St. 
John's  House  should  proceed  to  Scutari,  and  that 
he  should  himself  accompany  them,  "not  only 
to  be  their  guardian,  but  also  to  act  as  Chaplain 
generally  in  the  Hospital."  We  quote  part 
of  the  correspondence: 

From  the  Bishop  of  London  to  tlie  Master  of  St. 
John's  House 

FULHAM,    24th    Oct.,    1854. 

My  dear  Sir: 

I  quite  approve  of  both  parts  of  your  pro- 
posal, and  I  should  think  the  Council  would  also.  I 
have  written  to  Mr.  Sidney  Herbert  to  ascertain 
what  the  Government  will  do  in  the  matter. 

I  am,  yours  truly, 

C.  J.,  London. 

>  St.  John's  House  League  Xews,  Nov.,  1903,  pp.  126-127. 


Pre-Nightingale  Times  87 

From  the  Secretary  of  War  to  the  Bishop  of  London 

War  Office,  Oct.  17th,  1854. 
My  dear  Lord: 

Miss  Nightingale  has  consented  to  go  out  to 
Scutari  to  undertake  the  whole  management  of  the 
female  nursing.  Her  great  hospital  experience  and 
skill  and  courage  in  surgical  treatment,  together 
with  her  administrative  capacity,  peculiarly  fit  her 
for  this  undertaking,  and  in  a  Military  Hospital, 
where  subordination  is  everything,  without  some 
recognised  head  with  ample  authority,  there  would 
be  no  chance  of  success.  She  is  in  communication 
with  the  Nurses  of  St.  John's  House,  and,  I  have  no 
doubt,  will  take  them  with  her.   .  .  . 

Pray  believe  me,  yours  sincerely, 

Sidney  Herbert. 


Letters  were  written  to  the  Times  and  subscriptions 
asked  for  the  "St.  John's  House  Fund  for  the  Sick 
and  Wounded  English  in  the  East,"  also  volunteers 
for  the  work,  who  were  to  be  trained  by  St.  John's 
House  before  leaving  for  the  seat  of  war. 

After  various  negotiations  v/ith  the  government  and 
Miss  Florence  Nightingale,  it  was  finally  arranged 
that  St.  John's  House  should  furnish  a  certain 
number  of  its  nurses,  to  be  placed  under  the  sole  and 
exclusive  charge  of  Miss  Nightingale,  and  to  proceed 
with  her  without  delay  to  the  East.  At  a  meeting 
of  the  Council  in  October,  1854,  the  Secretary  of  War 
(Mr.  Sidney  Herbert),  the  Chaplain-General  to  the 
Forces,  and  Miss  Nightingale  attended  at  St.  John's 
House  in  order  to  facilitate  arrangements.  It  was 
resolved  that  in  the  great  public  emergency  the  insti- 


88  A  History  of  Nursing 

tution  would,  at  considerable  pecuniary  loss,  spare 
six  of  its  nurses  to  proceed  to  serve  under  Miss 
Nightingale  in  the  British  hospitals  in  the  East, 
and  that  they  should  be  entirely  under  her  juris- 
diction. The  original  plans  being  thus  altered,  and 
the  work  being  done  under  Government  instead  of 
by  the  institution,  the  services  of  the  Master  were 
not  required. 

On  October  23d  the  six  nurses — Rebecca  Law- 
field,  Emma  Fagg,  Ann  Higgins,  Elizabeth  Drake, 
Mary  Ann  Coyle,  Mary  Ann  Bournett — shaving  re- 
ceived a  parting  charge  and  benediction  from  their 
bishop,  started  for  Scutari,  and  were  accompanied 
by  the  Master  as  far  as  Paris.  The  Lady  Superin- 
tendent (Miss  Mary  Jones)  was  to  select  and  prepare 
additional  nurses  to  follow  this  first  detachment 
as  soon  as  possible.     Twenty  went  out  the  next  year. 

Four,  alas!  out  of  the  first  party  of  volunteers  re- 
turned shortly  from  Scutari,  not  being  prepared  to 
bear  and  accept  the  discipline  and  privations  of  the 
life  out  there.  The  remainder  served  their  country 
with  great  devotion,  as  the  following  entry  in  the 
Minute  Books  for  1855  testified: 

"The  Lady  Superior  has  also  received  an  anony- 
mous donation  of  ;^ioo  for  the  Institution  from 
*A  Sister  of  an  Officer  Fallen  in  the  Crimea.'  The 
donor  also  wishes  this  sum  added  to  the  fund  for  the 
purpose  of  building  a  suitable  residence  for  St.  John's 
House,  and  expresses  a  hope  that  the  House  may  be 
able  to  make  arrangements  for  taking  charge  of  the 
sick  in  King's  College  Hospital." 

Nurse  Elizabeth  Drake  died  of  fever  at  Balaclava, 
serving    at    her    post    faithfully    to    the    last.     Miss 


Pre-Nightingale  Times  89 

Nightingale  writes  of  her  in  the  highest  terms,  saying 
in  a  letter  dated  August  i6,  1855 :  "I  have  lost  in  her 
the  best  of  all  the  women  here.  ...  I  feel  like  a  crimi- 
nal in  having  robbed  you  of  one  so  truly  to  be  loved 
and  honoured.  It  seemed  as  if  it  pleased  God  to 
remove  from  the  work  those  who  have  been  most 
useful  to  it.  His  Will  be  done!"  Miss  Nightingale 
also  erected  a  small  marble  cross  to  her  memory  in 
the  cemetery  at  Scutari,  inscribed  with  her  name,  the 
date,  and  her  profession.  ^ 

The  providing  of  nurses  for  the  Crimea  was  the 
indirect  cause  of  a  great  expansion  in  the  work 
of  St.  John's  House,  for  the  need  of  systematic 
training  in  a  hospital  was  then  fully  and  widely 
acknowledged.  It  now  also  became  evident  that 
the  machinery  of  organisation  was  unwieldy  and 
delayed  progress,  as  there  were  no  less  than  five 
different  authorities  and  no  one  definite  head. 
The  Master's  report  of  1855  instanced  the  slow 
growth  of  the  institute  as  a  result  of  divided 
authority.  The  Lady  Superior  explained  it  by 
the  want  of  a  sufficient  and  well-defined  field  of 
labour,  and  the  lack  of  sufficient  hospital  facilities. 
So  far,  the  nurses  had  only  been  going  for  a  few 
hours  daily  to  learn  what  they  could  under  the 
paid  nurses  of  the  hospitals.  In  1853,  Miss 
Stanley  had  referred  to  their  results  in  the  fol- 
lowing words : 

There  has  been  great  comfort  afforded  to  the  rich 
by  these  nurses,  but  hitherto  the  original  promises 

»  St.  John's  House  League  News,  April,  1904,  pp.  126-1280 


90  A  History  of  Nursing 

have  not  been  fulfilled.  For  hospitals  it  [the  insti- 
tution] has  not  provided  at  all;  for  families  insuffi- 
ciently, and  for  the  poor  very  imperfectly.  It  has 
so  far  trained  seventeen  nurses,  but  it  is  now  greatly 
in  need  of  funds  and  -without  considerable  aug- 
mentation of  its  funds  it  cannot  go  on.^ 

About  this  time  propositions  were  made  to 
St.  John's  House  by  King's  College  hospital, 
which  had  been  founded  as  a  centre  for  teaching 
as  well  as  for  the  relief  of  the  sick  poor, 

as  to  whether  an  arrangement  could  be  entered  into 
by  which  the  entire  nursing  of  the  hospital  could  be 
undertaken  by  St.  John's  House.  Terms  of  agree- 
ment were  at  last  made  between  the  committees  of 
King's  College  Hospital  and  St.  John's  House,  and 
on  March  31,  1856,  the  Sisters  and  nurses  took 
over  the  work,  in  order  to  introduce  a  higher  class 
of  nurses  and  a  better  system  of  nursing  into  the 
wards  of  the  hospital,  and  to  carry  out  more  fully 
than  hitherto  one  main  object  of  the  St.  John's  In- 
stitution— that  of  training  and  providing  nurses  for 
the  sick  in  hospitals  as  well  as  for  private  families 
and  the  poor. 

Many  are  the  stories  told  of  the  day  the  Sisters 
took  possession ;  nearly  all  the  old  staff,  who  resented 
the  change,  waited  bonneted  and  cloaked  in  the  hall 
for  their  arrival,  and  then  left  at  once,  leaving  them 
"to  find  out  the  bad  cases  for  themselves";  and  by 
the  end  of  the  day  the  new-comers,  who  had  arrived 
in  clean  and  dainty  uniforms,  were  more  like  a  set 
of  sweeps  or  char- women,  in  such  an  appalling  state 

1  Hospitals  a'iid  Sisterhoods,  p.  46. 


Pre-Nightingale  Times  91 

of  disorder  had  they  found  their  wards.  Very  soon 
a  marked  improvement  began,  and  we  find  the  com- 
mittee warmly  thanking  the  Sisters  and  nurses  for 
their  devotion  to  their  duties.^ 

A  letter  in  the  Times  ^  describes  the  organisa- 
tion and  system  of  the  new  hospital  training  from 
the  time  of  its  foundation  in  1856.  The  staff 
consisted  of  a  lady  superior,  Sisters,  associate 
Sisters,  lady  pupils,  nurses,  assistant  nurses, 
probationers,  and  candidates  on  trial.  The  Sis- 
ters were  ladies  of  refinement  who  gave  their  ser- 
vices gratuitously  and  bore  the  cost  of  their  own 
maintenance.  They  entered  for  three  months' 
trial,  and  then  became  lady  pupils,  assistant 
Sister,  or  Sister.  The  probationers  were  usually 
of  the  servant  class  and  were  paid.  The  time 
of  probation  was  three  months.  They  then  be- 
came assistant  nurses  for  nine  months,  and  were 
thereafter  called  nurses.  The  time  of  training 
(one  year)  was  all  spent  in  the  hospital.  After 
that  the  nurses  were  employed  in  hospital  or  in 
private  duty.  St.  John's  House  took  charge  of 
the  entire  household  department  of  King's  Col- 
lege hospital,  the  kitchen,  the  store-rooms,  linen- 
rooms,  and  laundry;  it  retained  entire  control 
over  all  the  nursing  staff,  and  by  its  contract  with 
the  hospital  the  directors  or  ofBcers  of  the  latter 
were  not  to  interfere  so  long  as  the  nursing  was 
well  done.      The  wards  were  thoroughly  staffed 

»  St.  John's  House  League  News,  Oct.,  1904,  p.  184. 
2  Feb.  14,  1874. 


92  A  History  of  Nursing 

and  the  work  was  faultlessly  done,  as  innumer- 
able witnesses  testified.  The  patients  were  ten- 
derly nursed,  their  surroundings  kept  exquisitely 
clean  and  orderly,  and  an  atmosphere  of  refine- 
ment, sweet  cheerfulness,  and  serenity  characterised 
the  wards.  Miss  Nightingale  once  said  of  the 
nursing  there  that  it  was  the  most  ** homelike'* 
she  had  ever  seen.^ 

The  house  came  to  have  traditions  of  good  nurs- 
ing which  gave  it  an  atmosphere  greatly  cherished 
by  the  members.  The  patients  w^ere  always  put 
before  everything,  and  the  little  niceties  and  re- 
finements of  personal  care  were  steadily  impressed 
upon  the  probationers.  The  nurses  looked  for- 
ward to  spending  the  whole  of  their  nursing  days 
on  the  staff,  and  were  jealous  of  the  honour  and 
standards  of  the  house.  Many  of  them  spent 
twenty,  twenty-five,  and  thirty  years  in  private 
nursing,  and  then  retired  on  a  pension.  But  the 
present  generation  is  less  stationary  and  may  re- 
ceive a  larger  salary  in  lieu  of  the  pension. 

In  1 86 1  the  Lady  Superintendent  expresses 
her  opinion,  in  the  Report,  of  the  desirability  for 
the  completeness  of  St.  John's  House  that  the 
nurses  should  have  opportunity  for  training  in 
midwifery,  and  in  the  following  year  this  special 
branch  of  work,  for  which  ever  since  St.  John's 
House  has  been  famed,  was  taken  up. 

In    1874   a   struggle   took   place   between   the 

»  Quoted  by  Lord  Hatherly  in  a  letter  to  the  Times,  Febe 
28,  1874. 


Pre-Nightingale  Times  93 

administrative  authorities  of  the  hospital  and 
St.  John's  House,  which  was  written  up  freely 
in  the  Times  of  that  year,^  and  in  the  British 
Medical  Journal  of  the  same  date.^ 

The  contest,  which  was  in  brief  an  attempt  on 
the  side  of  the  hospital  officials  to  obtain  an 
aggressive  and  unfair  power  over  the  nursing 
staff,  which  would  have  impaired  discipline  and 
degraded  the  standards  of  nursing,  and,  on  the 
side  of  St.  John's  House,  to  defend  and  protect 
its  standards,  need  not  be  entered  into.  It  arose 
entirely  from  ignorance  of  what  good  nursing 
work  was,  on  the  side  of  certain*  hospital  offi- 
cials. It  is  of  interest,  however,  to  note  the  loyal 
support  given  to  the  House  by  the  medical  staff 
of  the  hospital,  and  by  the  Medical  Journal. 
The  latter  said  editorially:  "One  thing  is 
abundantly  evident,  and  that  is,  that  no  fault 
can  be  found  with  the  manner  in  which  the 
nursing  has  been  performed." 

The  hospital  staff  spontaneously  remonstrated 
with  the  committee,  saying  :  ''Any  change  which 
would  remove  the  nursing  from  the  care  of  the 
Sisters  of  St.  John's  House  is  greatly  to  be  de- 
precated and  would  be  calamitous  to  the  hospital 
and  to  the  interests  of  the  patients." 

The  difficulty  was  finally  adjusted  by  arbitra- 

»  See  Times,  Feb.  14,  18,  20,  28,  Apr.  27,  May  4,  15,  29, 
June  19.  1874. 

2  See  Journal  of  1874,  pp.  208,  243.  245,  283,  493,  591,  654, 
619,  592. 


94  A  History  of  Nursing 

tion  and  the  resignation  of  some  of  the  officials 
who  had  fomented  the  trouble,  and  St.  John's 
House  remained  in  charge  of  the  nursing  until 
1885,  when,  under  an  entirely  friendly  agreement, 
the  hospital  established  its  own  training  school. 

St.  John's  House  also  carried  on  the  nursing 
for  the  Charing  Cross  Hospital,  from  1866  to 
1889,  of  the  Metropolitan  Hospital  from  1888  to 
1896,  and  of  several  lesser  hospitals.  In  1883,  as 
the  result  of  an  unfortunate  controversy,  a  serious 
schism  occurred,  and,  a  majority  of  the  Sisters 
having  separated  from  the  House,  the  Council 
called  the  community  of  All  Saints  to  take  charge 
of  its  work.^  This  connection  lasted  for  ten  years, 
when.  All  Saints  having  urgent  calls  from  its 
foreign  missions,  it  withdrew  from  much  of  its 
English  work,  and  the  community  of  St.  Peter 
assumed  the  management  of  St.  John's  House, 
which   it   has   kept   until   the  present   day. 

St.  John's  House  is  in  many  respects  one  of  the 
most  interesting  and  attractive  nursing  founda- 
tions in  England.  It  has  drawn  to  its  service 
an  admirably  endowed  set  of  women,  and  has 
been  distinguished  by  an  extreme  liberality  and 
intelligence  of  view  in  social  questions.  As  a  re- 
fining factor  in  nursing  its  influence  is  hardly 
to  be  overestimated. 

As  we  are  now  attempting  only  an  outline  of  the 
early  history  of  the  Anglican  nursing  sisterhoods, 

1  The  seceding  Sisters  took  the  name  Nursing  Sisters  of  St. 
John  the  Divine,  and  established  themselves  in  Lewisham. 


St.  John's  House,  Queen's  Square 


Pre-Nightingale  Times  95 

the  important  part  which  St.  John's  House  has 
tsiken  in  modern  educational  questions,  and  its 
progressive  attitude  on  social  problems  must  be 
left  for  later  consideration.^ 

The  Sisterhood  of  All  Saints  is  peculiarly  en- 
titled to  the  interest  and  regard  of  American 
nurses,  for  it  was  to  this  community  that  Sister 
Helen,  who  organised  Bellevue  Training  School, 
belonged. 

All  Saints  has  had  a  distinctive  nursing  history. 
Its  first  Superior  was  Miss  Byron;  its  founder 
and  Chaplain  was  the  Rev.  Upton  Richards, 
Vicar  of  All  Saints,  Margaret  Street,  London.  Its 
existence  dates  from  185 1,  and  the  first  work  it 
undertook  for  the  care  of  the  sick  was  the  estab- 
lishment of  St.  Elizabeth's  Home  for  Incurable  Wo- 
men and  Children,  in  Mortimer  Street.  From  this 
arose  the  more  definite  and  systematic  relation  to 
hospital  nursing  which  came  to  characterise  this 
order.  In  1857  the  community  undertook  regular 
nursing  duties  in  University  College  hospital, 
several  wards  being  put  entirely  under  its  care, 
and  so  successful  was  its  administration  that  in 
1862  the  entire  charge  of  the  whole  hospital  was 
given  to  the  Sisters.  This  relation  between  hos- 
pital and  sisterhood  continued  until  1899,  when 
the  hospital  established  its  own  secular  school  of 
nursing.     Three  Sisters  held  in  turn,  during  the 

»  We  are  indebted  to  Miss  Margaret  Breay,  Hon.  Secretary 
of  the  Matrons'  Council  of  Great  Britain  and  Ireland,  for 
many  details  of  St.  John's  House  history. 


96  A  History  of  Nursing 

whole  time,  over  thirty  years,  the  position  of 
Sister-in-Chief  in  the  hospital:  they  were  Sister 
Elizabeth,  Sister  Gertrude  Anna,  and  Sister 
Cecilia. 

The  relation  with  St.  John's  House,  which 
dated  from  1883  and  continued  until  1893,  brought 
an  enlarged  field  of  hospital  nursing  to  the  com- 
munity of  All  Saints — the  ^letropolitan  hospital, 
St.  Saviour's,  and  the  Maternity  at  Battersea  all 
for  a  time  comnng  under  its  care.  Increasing 
demands  from  foreign  countries  led  the  community 
to  relinquish  some  of  its  English  posts,  but  it  still 
cares  for  a  large  convalescent  hospital  at  East- 
bourne for  men,  women,  and  children,  and  a 
children's  hospital  in  the  same  place  which  was 
built  in  memor\'  of  the  Mother  Foundress.  The 
Sisters  are  now  active  in  Bombay,  where  nursing 
is  a  prominent  feature  of  the  branch  house.  Two 
or  three  hospitals  are  under  their  management 
there,  and  during  the  plague  of  1899  they  supplied 
the  nursing  in  eight  hospitals,  some  o^^  which, 
however,  were  temporary  structures.^ 

Another  sisterhood  which  made  nursing  a 
special  interest,  and  still  does  so,  was  St. 
Margaret's,  founded  by  the  Rev.  Dr.  Neale  in 
1854.  A  rarely  fresh  and  mediaeval  fen'our  seems 
to  have  characterised  this  little  community  under 
the  leadership  of  Dr.  Neale,  who  was  another  St. 
Francis,  poetic  and  artistic,  more  scholarly  also 
than   St.    Francis   probably  was.     Its   story  has 

»  From  private  sources. 


Pre-Nightingale  Times  97 

been  told  in  a  very  engaging  and  unaffected  style 
by  one  of  the  Sisters.^ 

A  short  experience  of  hospital  work  was  regarded 
as  sufficient  preparation  for  the  demands  made 
upon  the  Sisters ;  they  did  not  include  any  private 
work  among  the  rich  in  their  nursing  plans,  but 
devoted  themselves  to  the  service  of  the  poor. 
Sincere  and  unselfish  devotion,  with  zeal  to  per- 
form the  most  menial  duties  of  scrubbing  and 
cleaning  in  their  patients'  homes,  constituted 
the  chief  outfit  in  the  nursing  armoury  of  the 
Sisters.  Dr.  Neale's  idea  was  that  still  found 
to-day  among  the  clergy — nursing  was  not  re- 
garded as  a  specialty,  but  as  an  accessory  to 
general  mission  w^ork.  The  Sisters  were  often 
sent  to  remain  with  a  patient.  *'  If  a  Sister  was 
nursing  in  some  lonely  out-of-the  way  hamlet  he 
(Dr.  Neale)  would  always  find  time  and  go  to  see 
her  at  least  once  during  her  period  of  nursing," 
runs  the  memoir  spoken  of.^  And  a  letter  written 
by  Dr.  Neale  to  an  applicant,  fixing  a  day  for  her 
to  be  met  by  one  of  the  band,  said,  "All the  oth- 
ers [the  Sisters]  are  out  nursing."  The  Sisters  went 
sometimes  to  one,  sometimes  to  another  hospi- 
tal to  gain  their  experience.  Sectarian  animosity 
sometimes  made  it  hard  for  them  to  get  even 
this  little  training.  One  letter,  dated  December 
13,  1859,  said:     ''Will  you  tell  A.  L.  that  if  she 

»  Memories  of   a   Sister  of  St.  Saviour's   Priory.     London. 
A.  R.  Mowbray  Co.,  1904. 
2  Page  30. 
VOL.  n. — 7. 


gS  A  History  of  Nursing 

wants  to  go  to  the  hospital  she  must  go  before 
she  is  a  Sister,  for  Sister  Martha  cannot  get  admis- 
sion into  one  on  account  of  her  cross,  and  Dr. 
Neale  ^vill  not  let  her  put  it  off."  ^ 

A  frightful  scene  of  superstitious  hatred  was 
enacted  one  time  at  a  funeral  of  one  of  the  Sis- 
ters, when  mob  brutality  burst  forth,  and  a  couple 
of  the  Sisters  were  almost  torn  in  pieces  and 
had  to  be  taken  under  escort  of  the  police  to  a 
place  of  safety. 

In  many  years'  work  in  Soho,  St.  Giles,  and 
Haggerston  the  Sisters,  in  spite  of  their  elementary 
training,  fearlessly  braved  small-pox,  typhoid,  and 
cholera.  Several  of  them  helped  to  nurse  in  Miss 
Sellon's  temporary  hospital  in  Spitalfields,  she 
and  Dr.  Pusey  having  taken  a  large  warehouse  and 
fitted  it  up  for  the  purpose,  receiving  there  men, 
women,  and  children.  Sisters  of  Holy  Trinity 
also  assisted  there,  while,  in  true  mediaeval  fash- 
ion, the  Cowley  Brothers  under  Father  Grafton 
helped  in  the  men's  wards  and  in  the  kitchen. 

Small-pox  was  a  frequent  scourge,  and  the 
Sisters  relate  a  number  of  inconceivably  pathetic 
instances  of  its  horrors:  one  story  tells  how  they 
themselves,  by  night,  carried  the  little  coffin  of  a 
child,  which  no  one  else  would  touch,  to  the 
morgue;  and  another  of  four  children  in  one  bed, 
two  of  whom  were  dead  of  small-pox  and  two  liv- 
ing, but  all  in  so  much  the  same  state  that  the 
undertaker   who  had  come  to  remove   the    dead 

>  Mefnories  of  a  Sister  of  St.  Saviour's  Priory,  p.  2q. 


Pre-Nightingale  Times  99 

bodies  hesitated,  when  the  Hving  children  cried, 
*'0h,  Mother,  Mother,  don't  let  us  go  too." 

In  187 1  the  Sisters  were  so  overwhelmed  with 
calls  to  small-pox  patients  that  they  appealed  for 
aid  in  the  Times  of  Feb.  20.  Besides  visiting,  four 
Sisters  worked  continuously  in  an  emergency  hos- 
pital for  small-pox  on  the  Hackney  Road.^ 

In  later  years,  after  the  Jubilee  Nurses  were 
established  and  a  branch  was  placed  in  Nichols 
Square,  the  Sisters  wrote :  "  How  we  ever  managed 
to  help  our  poor  sick  people  before  those  invaluable 
nurses  came  I  cannot  think.  We  did  the  little 
we  could  ourselves,  just  in  our  own  parish,  but  it 
was  but  a  tiny  drop  in  the  ocean  of  sickness  and 
misery.  Now  it  rejoices  the  heart  of  every  one  to 
see  the  bright,  cheery,  kindly  face  of  the  nurse 
going  about  on  her  errands  of  helpfulness  and 
accomplishing  on  a  very  large  scale,  with  trained 
skilfulness,  what  we  used  to  attempt  on  a  very 
small  scale  with  anxious  unskilfulness."  ^ 

We  have  now  followed,  at  least  in  outHne,  the 
early  efforts  and  achievements  in  English  nursing 
reform.  It  is  clear  that,  admirable  as  was  the 
spirit  animating  them,  high  as  were  the  ideals, 
and  great  the  energy  and  courage  of  these  early 
reformers  and  pioneers,  yet,  indisputably,  their 
nursing  organisations,  modelled  as  they  all  were, 
more  or  less  consciously  and  of  set  design,  on  the 
forms  of  the  past  (thus  being,  in  fact,  imitations, 

»  Memories  of  a  Sister  of  St.  Saviour's  Priory,  p.  123-124. 
2  Ibid.,  p.  304. 


loo  A  History  of  Nursing 

or  survivals  of  a  former  order  of  things) ,  did  not 
contain  within  themselves  the  principle  of  growth 
or  adaptation  to  new  social  forms.  Society  was 
about  to  take  on  a  new  phase — the  industrial — a 
phase  unlovely  in  itself,  but  beyond  which  fairer 
domains  of  social  justice  might  be  descried ;  medi- 
cine was  about  to  become  a  new  and  commanding 
science:  based  on  research  and  allied  with  a  glori- 
ous figure — sanitation,  that  had  well-nigh  disap- 
peared for  over  2000  years  from  the  earth — the 
medical  art  was  now  preparing  to  proclaim  the 
doctrines  of  prevention  rather  than  the  assuage- 
ment of  disease.  Even  religion,  that  for  so  many 
centuries  had  decided  the  forms  and  extent  of  the 
nurse's  ministrations,  was  on  the  eve  of  turning 
from  a  sole  contemplation  of  the  next  world,  to 
this  one,  to  become  less  abstract  and  more  prac- 
tical. The  creative  energy  that  was  to  transform 
the  nursing  of  England  and  of  a  new  continent 
was  even  then  ready  to  break  forth.  Miss  Night- 
ingale was  preparing,  not  to  imitate  the  forms  of 
the  past,  but  to  shape  a  new  order;  not  to  repro- 
duce the  Sisters  of  Charity  or  the  deaconesses, 
but  to  re-create  the  ancient  work  of  nursing  on  a 
plan  fitted  for  and  adapted  to  the  oncoming 
changes  of  the  future. 


CHAPTER  III 

MISS  NIGHTINGALE  AND  THE  CRIMEAN    WAR 

FLORENCE  NIGHTINGALE,  the  revered 
foundress  of  modern  trained  nursing,  the 
heroine  of  the  Crimea  and  the  guiding  spirit  in  a 
long  series  of  reforms  in  military  and  civil  hospital 
administration  and  public  hygiene,  was  bom  in 
May,  1820,  and  is  still  living.  Her  chief  contribu- 
tion to  the  inheritance  of  the  race  has  been  that, 
besides  demonstrating  in  action  the  full  perfection 
of  the  allied  arts  of  nursing  and  sanitation,  she 
has  left  in  her  writings  a  philosophy,  as  it  were,  of 
nursing,  together  with  an  intellectual  demonstra- 
tion of  the  scientific  and  natural  basis  of  hygiene 
and  its  practical  application,  and  has  laid  down 
once  and  for  all  their  essential  underlying  princi- 
ples with  a  clarity,  a  logic,  an  originality,  and  a 
depth  of  reflection  that  mark  the  genius  and  place 
her  works  among  the  classics. 

A  complete  and  authoritative  history  of  Miss 
Nightingale  is  naturally  not  to  be  expected  until 
she  or  some  authorised  member  of  her  family 
shall  decide  to  give  it  to  the  world.  All  through 
her  long  life  she  has  shown    great  reticence  as 

lOI 


I02  A  History  of  Nursing 

to  her  own  achievements,  and  has  displayed  a  self- 
detachment  as  great  as  her  deeds — amounting 
even  to  an  aversion  to  being  written  about.  But 
public  services  as  distinguished  as  hers  could  not 
be  left  untold,  and  a  number  of  biographies, 
more  or  less  fragmentary,  and  biographical 
chapters  in  histories  of  the  Crimean  War  have 
been  written  of  her.  It  is  indeed  doubtful 
w^hether  any  woman's  story  has  been  repeated 
oftener,  or  with  greater  homage,  admiration,  and 
gratitude.  Yet  every  one  of  the  existing  accounts 
of  Miss  Nightingale  falls  far  short  of  being  pro- 
portioned to  her  place  in  the  sphere  of  social 
progress.  It  is  true  that  certain  chapters  in 
Crimean  War  histories  w^hich  are  devoted  to  her 
work  have  the  most  genuine  ring,  as  of  personal 
knowledge,  but  they  touch  only  that  one  epoch 
of  her  long  and  consistently  useful  life.  Of  the 
earlier  biographies^  aiming  at  a  general  account  of 
Miss  Nightingale,  it  is  not  evident  that  any  of 
the  writers  was  able  to  draw  from  sources  other 
than  the  daily  press  and  records  open  to  every  one, 
while  of  later  ones  it  may  be  assumed  that  they 
contain  only  second-hand  material,  rewritten  in 
a  new  setting.  Hence  it  has  been  inevitable  that 
a  somewhat  conventionalised  saintly  type,  not 
unlike  that  of  the  mediaeval  legends,  has  come  to 
be  accepted  as  the  orthodox  figure  of  Miss  Night- 
ingale, so  that  it  is  not  always  clear  how  much  of 
the  human  and  real  personality  of  this  great 
iSee  bibliography  in  appendix. 


Miss  Nightingale  and  Crimean  War  103 

woman  is  shown.  This,  indeed,  the  writers  beHeve, 
is  only  to  be  fairly  estimated  by  a  close  and 
thorough  study  of  her  writings. 

The  most  serious  and  adequate  accounts  of 
Miss  Nightingale's  army  nursing  work  have  been 
given  by  men,  notably  by  Kinglake,  who  more 
than  any  other  recognised  and  delineated  ac- 
curately the  intellectual  quality  of  her  achieve- 
ments in  the  Crimea;  but  few  indeed  are  they 
who  read  Kinglake  to-day,  and  his  graphic  and 
fascinating  portrayal  of  the  Lady-in-Chief  is 
hidden  in  the  oblivion  which  now  obscures  the 
Crimean  War.  Few  persons  have  wielded  influence 
so  extensive  as  hers,  and  no  other  has  had  so 
definite  and  weighty  a  share  in  shaping  and  advis- 
ing in  hospital  and  nursing  affairs;  and  yet  so 
quietly  and  unassumingly  has  this  influence  been 
exercised  from  her  invalid's  couch,  that  few  of  those 
directly  benefited  by  her  counsels  have  known  their 
source.  Her  writings,  too,  containing  as  they  do 
incomparable  statements  of  principles,  enunciated 
with  consummate  mental  supremacy,  have,  un- 
fortunately, been  largely  hidden  away  in  Blue 
Books,  reports,  proceedings,  and  encyclopedias. 
With  the  exception  of  the  Notes  on  Nursing; 
What  it  Is  and  What  it  is  Not,  which  finds  a  place 
in  all  well-selected  libraries,  they  are  not  readily 
accessible  to  the  general  public,  and  are  all  but 
unknown  to  the  younger  women  who  are  following 
the  nurse's  calling.  We  must  hope  that  some  day 
we  may  know  the  full  inner  history  of  her  long 


I04  A  History  of  Nursing 

years  of  experience  and  obser\^ation  in  the  many 
hospitals  of  Europe;  of  her  training  at  Kaisers- 
werth ;  of  the  vast  miHtary  hospital  system  in  the 
Crimea  to  which  she  applied  her  controlling  mind 
and  hand ;  of  her  confidential  reports,  commiuni- 
cations,  suggestions  to  the  War  Office,  and  im- 
portant share  in  the  reorganisations  that  followed 
the  war;  of  those  early  days  in  nursing  reform 
when  all  work  was  pioneer  work,  and  every  new 
step  an  experiment  and  a  revolution;  of  the  in- 
numerable conferences,  the  unceasing  current  of 
advice,  suggestion,  and  inspiration,  that  flowed 
in  all  directions  from  her  sick-room. 

A  work  has  recently  appeared^  which  contains 
certain  hitherto  unpublished  material  concern- 
ing the  Crimean  epoch,  but  in  so  fragmentary 
a  form  that  it  adds  little  or  nothing  to  the 
already  existing  records  of  importance  that 
refer  to  that  period;  moreover,  it  is  knit  in  a 
context  so  biassed  and  narrow,  and  interpreted  in 
a  spirit  so  small  and  acrimonious,  that  it  is  more 
calculated  to  mislead  than  to  enlighten. 

The  writers  realise  well  their  limitations  in 
being  unable  to  present  any  new  and  authoritative 
material  relating  to  Miss  Nightingale  and  her  life : 
what  they  have  tried  to  do  is  to  gather  together 
those  records  and  bits  of  scattered  personal 
testimony  which  seem  the  most  valuable    and  to 

»  Sidney  Herbert,  Lord  Herbert  of  Lea,  A  Memoir,  by  Lord 
Stanmore.  In  2  volumes.  John  Murray,  London;  E.  P. 
Dutton  &  Co.,  New  York,  1906, 


Miss  Nightingale  and  Crimean  War  105 

interpret  them,  so  far  as  lies  in  their  power,  by 
virtue  of  a  common  calling. 

A  generous  fate  seems  to  have  presided  at 
Miss  Nightingale's  birth,  for  every  advantage  of 
family,  social  position,  culture,  and  wealth  was 
hers.  But  most  grateful  must  her  followers  feel 
to  her  father,  w^hose  passion  for  education  so  far 
outran  the  standards  of  his  day  that  he  was  in- 
different to  sport — that  idol  of  his  contemporaries 
— and  cool  toward  local  charities  and  alms-givings, 
but  ardent  in  his  support  of  schools  for  the  rural 
population.  To  this  enlightened  father  we  owe 
it  that  Miss  Nightingale  was  educated  with  a 
breadth,  scope,  and  thoroughness  uncommon  not 
only  then,  but  now.  Her  mother,  a  woman  of 
beautiful  and  gracious  personality,  herself  the 
daughter  of  a  notably  liberal  and  philanthropic 
father,  endowed  her  with  every  kindly  and  gentle 
gift,  and  taught  her  social  accomplishments;  but 
her  father  trained  and  disciplined  her  mind, 
fortified  it  with  an  ample  stock  of  Greek  and  Latin, 
mathematics,  and  natural  science,  made  her  pro- 
ficient in  German,  French,  and  Italian,  and  took 
her  through  ancient  and  modern  literature.  In 
the  delightful  Memoirs  of  Caroline  Fox  is  found 
this  anecdote: 

June  12th  [1857]  Warrenton  Smythe  talked  with 
great  delight  of  Florence  Nightingale.  Long  ago, 
before  she  went  to  Kaiserswerth,  he  and  Sir  Henry 
de  la  B^che  dined  at  her  father's  and  Florence 
Nightingale  sat  between  them.     She  began  by  draw- 


io6  A  History  of  Nursing 

ing  Sir  Henry  out  on  geology  and  charmed  him  by 
the  boldness  and  breadth  of  her  views,  which  were 
not  common  then.  She  accidentally  proceeded  into 
regions  of  Latin  and  Greek  and  then  our  geologist 
had  to  get  out  of  it. 

She  was  fresh  from  Egypt  and  began  talking  with 
W.  Smythe  about  the  inscriptions,  etc.,  where  he 
thought  he  could  do  pretty  well ;  but  when  she  began 
quoting  Lepsius,  which  she  had  been  studying  in  the 
original,  he  was  in  the  same  case  as  Sir  Henry. 

When  the  ladies  left  the  room,  the  latter  said  to 
him,  "A  capital  young  lady  that,  if  she  hadn't  floored 
me  with  her  Latin  and  Greek.  ^ 

It  has  been  said  of  her:  '' The  peculiarity  in  the 
case  of  herself  and  her  relatives  seems  to  be  their 
having  been  reared  in  an  atmosphere  of  sincerity 
and  freedom — of  reality,  in  fact — which  is  more 
difficult  to  obtain  than  might  be  thought.  "^ 

Much  as  Miss  Nightingale  owed  to  her  family 
inheritance,  she  was  even  more  a  product  of  her 
times.  The  nineteenth,  often  called  the  woman's 
century,  was  one  of  unexampled  richness  in 
strong  personalities,  insistent,  inquiring  minds, 
protest,  dissent,  research,  discovery,  and  reform. 
The  span  of  Miss  Nightingale's  days  was  the  time 
of  Owen  and  Shaftesbury ;  of  Huxley  and  Darwin ; 
of  John  Stuart  Mill  (whom  she  ardently  admired) , 
Mrs.  Fry,  Harriet  Martineau,  Mrs.  Jameson  and 

^Memories  of  Old  Friends.  Extracts  from  the  Journal 
and  Letters  of  Caroline  Fox,  1S83,  p.  336.  By  permission 
of  the  publishers,  J.  B.  Lippincott  Co.,  Philadelphia. 

2  Life  of  Florence  Nightingale,  by  Ingleby  Scott,  in  Notes 
on  Nursing.     William  Carter,  Boston,  i860,  p.  i. 


Miss  Nightingale  and  Crimean  War  107 

Louisa  Twining,  George  Eliot,  Margaret  Fuller, 
and  the  Brownings.  It  was  the  time  when  a  whole 
galaxy  of  strong  notable  women  began  working  for 
causes,  reforms,  and  progress;  writing,  striving, 
and  demanding  to  speak  for  emancipation  and 
justice.  As  early  as  18 16  an  article  written  by 
Catherine  Coppe  had  appeared  in  the  Pamphleteer 
called  "On  the  Desirability  and  Utility  of  Ladies 
Visiting  the  Female  Wards  of  Hospitals  and  Lun- 
atic Asylums."  It  was  a  dignified  appeal,  very 
gentle,  unaggressive,  and  touching.  The  writer 
spoke  of  the  "debate  still  at  issue  respecting  the 
official  appointment  of  females  to  visit  the  apart- 
ments of  those  of  their  own  sex ;  "  of  the  great 
evil  of  political  appointees  in  such  institutions. 
She  touched  bravely  on  the  jealousy  of  men 
in  fearing  an  enlarged  influence^  and  sphere  of 
activity  for  women,  but  mentioned  two  institu- 
tions, York  County  hospital  and  a  lunatic  asylum, 
where  the  practice  of  having  female  visitors  had 
been  established,  the  former  in  18 14  and  the 
latter  in  181 5.  While  Miss  Nightingale  w^as  in- 
vestigating hospital  and  nursing  conditions,  ruling 
in  the  Crimea,  and  founding  St.  Thomas's  Train- 
ing School  for  Nurses,  Mary  Carpenter  was  toiling 
in  Ragged  Schools,  Mrs.  Jameson  was  lecturing 
on  the  "Social  Employments  of  Women,"  and 
the  "Community  of  Labour,"  and  urging  the 
opening  of  the  great  institutions  of  misery  and 
poverty  as  schools  for  the  training  of  kind-hearted, 
helpful  women,   whose  energy  was  then  wasted 


io8  A  History  of  Nursing 

for  want  of  a  vocation,  and  declaring  the  bitter 
need  of  the  inmates  of  hospitals,  prisons,  asylums, 
workhouses,  and  reformatories,  in  all  of  which, 
under  the  routine  machine-like  control  of  men, 
the  poor,  the  sick,  and  the  delinquent  were 
suffering  for  the  care  of  compassionate  and 
motherly  w^omen. 

It  was  the  time  of  the  estabhshment  of  the 
National  Association  for  the  Promotion  of  Social 
Science,  at  w^hose  meetings  some  of  Miss  Nightin- 
gale's epoch-making  papers  which,  according  to 
Lord  Brougham,  were  the  most  important  ever 
presented  to  it,  were  read;  of  the  first  w^omen 
pioneers  in  university  education,  medicine,  and 
the  suffrage  movement.  John  Stuart  Mill  was 
writing  on  "Liberty"  and  the  ''Subjection  of 
Women,"  and  a  little  later  Arnold  Toynbee 
went  to  live  in  the  East  Side  of  London.  No  less 
significant  for  the  futiu-e  of  nursing  was  the  fact 
that,  contemporaneously  with  the  woman  who 
was  to  revolutionise  this  ancient  calling,  lived  the 
scientist  who  was  to  herald  the  change  of  the 
whole  course  of  medicine.  Lister  was  studying 
in  the  medical  school  while  Miss  Nightingale  was 
training  herself  at  Kaiserswerth.  Three  years 
after  the  declaration  of  peace  following  the  Cri- 
mean war,  when  Miss  Nightingale  had  laid  her 
plans  for  St.  Thomas's  Training  School  and  all  was 
in  readiness  for  it  to  open,  Lister  published  his 
Early  Stages  of  Inflammation;  and  in  1875, 
as  one  hospital  after  another  was  adopting  the 


Miss  Nightingale  and  Crimean  War  109 

system  marked  out  by  the  skilled  hands  and 
controlling  mind  of  Miss  Nightingale  for  the  care 
of  patients,  Lister  brought  out  his  Theory  of 
Fermentative  Changes  which  marked  a  new 
epoch  in  medicine  and  surgery.  What  the  union 
of  science  with  skilled  nursing  was  to  do  for 
hospitals  can  be  realised  by  reading  some  of  the 
titles  of  the  papers  read  before  medical  meetings 
just  before  that  time:  "Epidemic  Erysipelas  in 
Hospitals,"  "Relation  between  Diphtheria  and 
Gangrene  and  Hospital  Plague,"  "Alleged  Greater 
Mortality  of  Fevers  in  Hospitals  than  in  Homes  of 
the  Poor,"  "Poison  Saturation  of  Old  Hospitals." 
Nor,  in  fact,  do  many  modern  nurses  know  even 
by  name  the  scourges  w^hich  were  familiar  entities 
to  the  attendants  in  hospitals  in  that  day« 

Miss  Nightingale  may  be  regarded  as  a  most 
impressive  example  of  a  human  being  in  whom 
inherent  genius  and  natural  inclination  w^ere 
allowed  the  fullest  development  and  expression. 
In  her  the  true  nurse  seems  to  have  been  born, 
as  well  as  made.  Her  earliest  tastes  inclined 
that  way,  and  few  of  her  biographers  have 
omitted  the  story  of  Shep,  the  wounded  collie 
dog.  It  is  said  that  when  she  was  a  very  young 
girl  one  of  Pastor  Fliedner's  reports  fell  into  her 
hands  and  made  a  deep  impression  on  her,  even 
making  her  vocation  clear  to  her.  ^  Julia  Ward 
Howe  has  given  an  interesting  glimpse  of  this 

»  Life  of  Pastor  Fliedner,  Winkworth,  London,  1867.  p. 
128. 


no  A  History  of  Nursing 

early  desire  to  study  nursing  in  the  year  1844, 
when  she  and  Dr.  Howe  were  abroad.  Miss 
Nightingale  was  then  twenty-four  years  old. 

Mrs.  Bracebridge,  in  speaking  to  me  of  Florence 
Nightingale  as  a  young  person  likely  to  make  an  ex- 
ceptional record,  told  me  that  her  mother  rather 
feared  this,  and  would  have  preferred  the  usual 
conventional  life  for  her  daughter.  The  father  was 
a  pronounced  Liberal,  and  a  Unitarian.  While  we 
were  still  at  Atherstone,  we  received  an  invitation 
to  pass  a  few  days  with  the  Nightingale  family  at 
Embley,  and  betook  ourselves  thither.  We  found  a 
fine  mansion  of  Elizabethan  architecture,  and  a 
cordial  reception.  The  family  consisted  of  father  and 
mother  and  two  daughters,  both  born  during  their 
parents'  residence  in  Italy,  and  respectively  christened 
Parthenope  and  Florence,  one  having  first  seen  the  light 
in  the  city  whose  name  she  bore,  the  other  in  Naples. 

Of  the  two  Parthenope  was  the  elder;  she  was  not 
handsome,  but  was  piquante  and  entertaining- 
Florence,  the  younger  sister,  was  rather  elegant  than 
beautiful;  she  was  tall  and  graceful  of  figure,  her 
countenance  mobile  and  expressive,  her  conversation 
most  interesting.  Having  heard  much  of  Dr.  Howe 
as  a  philanthropist,  she  resolved  to  consult  him  upon  a 
matter  which  she  already  had  at  heart.  She  accord- 
ingly requested  him  one  day  to  meet  her  on  the  follow- 
ing morning,  before  the  hour  of  the  family  breakfast. 
He  did  so,  and  she  opened  the  way  to  the  desired 
conference  by  saying,  "Dr.  Howe,  if  I  should  de- 
termine to  study  nursing,  and  to  devote  my  life  to 
that  profession,  do  you  think  it  would  be  a  dreadful 
thing?" 


Miss  Nightingale  and  Crimean  War  1 1 1 

"By  no  means,"  replied  my  husband,  "I  think 
that  it  would  be  a  very  good  thing. " 

So  much  and  no  more  of  the  conversation  Dr. 
Howe  repeated  to  me.  We  soon  heard  that  Miss 
Florence  was  devoting  herself  to  the  study  of  her 
predilection;  and  when,  years  after  this  time,  the 
Crimean  War  broke  out,  we  were  among  the  few  who 
were  not  astonished  at  the  undertaking  which  made 
her  name  world-famous.  ^ 

A  similar  glimpse,  but  of  an  occurrence  that 
happened  after  Miss  Nightingale  had  been  at 
Kaisers werth,  is  given  by  Dr.  Elizabeth  Blackwell, 
another  revered  figure  among  pioneer  women, 
who  became  well  acquainted  with  Miss  Nightin- 
gale. She  speaks  of  her  as  a  young  lady  at  home 
chafing  under  the  restrictions  that  crippled  her 
active  energy,  and  recalls  the  many  hours  that 
they  spent  together  in  discussing  the  problems 
of  the  present  and  the  hopes  of  the  future.  Of 
one  of  these  visits,  she  writes  in  a  letter  to  her 
sister,  April  17,   1851  : 

Walked  much  with  Florence  in  the  delicious  air 
...  at  Embley  Park.  As  we  walked  on  the  lawn  in 
front  of  the  noble  drawing-room  she  said:  "Do  you 
know  what  I  always  think  when  I  look  at  that  row 
of  windows?  I  think  how  I  should  turn  it  into  a 
hospital,  and  just  how  I  should  place  the  beds.  "^ 

1  Reminiscences  of  Julia  Ward  Howe.  Houghton  &  Mifflin, 
Boston,  1900.    pp.  137-138. 

2  Pioneer  Work  in  Opening  the  Medical  Profession  to 
Women,  Dr.  Elizabeth  Blackwell.  Longmans,  Green,  &  Co., 
London.   1895.    p.    185 


112  A  History  of  Nursing 

Possessing  the  natural  gift,  no  one  ever  cultivated 
it  more  thoroughly  than  she.  Just  how  much 
time  she  spent  in  studying  hospital  conditions  we 
do  not  know  exactly,  but  certainly  a  period  of 
several  years  was  devoted  to  a  careful  and  system- 
atic examination  of  hospitals  in  England, 
Scotland,  Ireland,  France,  Belgium,  Germany, 
and  Italy,  and  to  the  study  of  nursing  history, 
before  Miss  Nightingale  went  to  Kaiserwerth  to 
be  trained  as  a  nurse.  Her  own  words  are  well 
worth  remembering: 

I  would  say  to  all  young  ladies  who  are  called  to 
any  particular  vocation,  qualify  yourselves  for  it  as 
a  man  does  for  his  work.  Don't  think  you  can 
understand  it  otherwise.  Submit  yourselves  to  the 
rules  of  business  as  men  do,  by  which  alone  you 
can  make  God's  business  succeed,  for  He  has  never 
said  that  He  will  give  His  success  to  sketchy  and 
unfinished  work.^ 

Another  time  she  wrote: 

Three  fourths  of  the  whole  mischief  of  women's 
lives  arises  from  their  excepting  themselves  from  the 
rules  of  training  considered  needful  for  men.^ 

Miss  Nightingale  went  to  Kaiserswerth  for 
two  weeks'  study  in  1850,  and  again  for  three 
months  (some  weeks.  Pastor  Fliedner  wrote), 
in  1 85 1.     Only  scanty  records  of  her  stay  there 

1  From  an  article  on  Kaiserswerth. 

2  From  "Una,"  introduction  to  Memorials  of  Agnes  Eliz- 
abeth  Jones,  by  her  sister.     London,    1885.  p.   xxxii. 

'  From  anonymous  biography  in  Notes  on  Nursing,  editioo 
i860. 


Miss  Nightingale  and  Crimean  War  113 

are  to  be  found,  but  personal  recollections  of  aged 
Sisters  have  testified  to  the  distinguished  ability 
of  the  English  lady.  Sidney  Herbert,  who  was 
later  destined,  as  Secretary  at  War,  to  put  her  in 
charge  of  the  Crimean  military  hospitals,  visited 
her  here  as  an  old  friend,  saw  her  at  work, 
and  heard  the  encomiums  of  the  Fliedners  upon 
her  work.  Of  Kaiserswerth,  Miss  Nightingale  said 
afterwards : 

I  was  twice  in  training  there  myself.  Of  course, 
since  then  hospital  and  district  nursing  have  made 
giant  strides — indeed,  district  nursing  has  been  in- 
vented; but  never  have  I  met  with  a  higher  tone,  a 
purer  devotion,  than  there.  There  was  no  neglect. 
It  was  the  more  remarkable  because  many  of  the 
deaconesses  had  been  only  peasants;  none  were 
gentlewomen  when  I  was  there.  The  food  was  poor. 
No  luxury  but  cleanliness.  ^ 

She  next  spent  some  time  with  the  Sisters  of 
St.  Vincent  de  Paul  in  Paris,  studying  French 
surgery,  which  was  famous,  and  the  admirable 
method  of  institutional  administration  and  man- 
agement of  the  Sisters.  It  was  his  knowledge 
of  her  long,  rigorous,  and  adequate  training,  and  of 
the  executive  ability  she  had  shown  later  in  bring- 
ing order  out  of  chaos  in  the  Harley  St.  Home  for 
Sick  Governesses,  as  well  as  personal  admiration 
for  her  as  an  old  and  intimate  friend,  that  prompted 
Sidney  Herbert,  when  the  storm  of  war  broke 
in  the  East,  and  the  appalling  break-down  in  the 
•In  a  letter  preserved  in  the  British  Museum. 

VOL.  II. — 8 


114  A  History  of  Nursing 

hospital  service  became  known,  to  write  to  her 
from  the  War  Office  urging  her  to  go  to  the  rescue, 
with  the  words:  "There  is  but  one  person  in 
England  that  I  know  of  who  would  be  capable  of 
organising  such  a  scheme." 

The  Crimean  War  had  broken  out  in  March, 
1854,  and  with  the  news  of  the  first  battles  had 
come  grievous  accounts  of  neglect  and  misman- 
agement in  the  medical  department;  Russell, 
the  special  correspondent  of  the  Times,  wrote  on 
Sept.  26,  1854: 

It  is  with  feelings  of  surprise  and  anger  that  the 
public  will  learn  that  no  sufficient  preparations  have 
been  made  for  the  wounded.  Not  only  are  there  not 
sufficient  surgeons — that,  it  might  be  urged,  was 
unavoidable ;  not  only  are  there  no  dressers  and  nurses 
— that  might  be  a  defect  of  system  for  which  no  one 
is  to  blame;  but  what  will  be  said  when  it  is  known 
that  there  is  not  even  linen  to  make  bandages  for 
the  wounded — after  the  troops  have  been  six  months 
in  the  country,  there  is  no  preparation  for  the  com- 
monest surgical  operation?  Not  only  are  the  men 
kept,  in  some  cases,  for  a  week  without  the  hand  of 
a  medical  man  coming  near  their  wounds;  not  only 
are  they  left  to  expire  in  agony,  unheeded  and  shaken 
off,  though  catching  desperately  at  the  surgeon 
whenever  he  makes  his  rounds  through  the  fetid 
ship,  but  now,  when  they  are  placed  in  this  spacious 
building  [the  Barrack  Hospital  at  Scutari],  it  is 
found  that  the  commonest  appliances  of  a  British 
workhouse  sick  wards  are  wanting.^ 

^The  Times,  Oct.   12,  1854. 


Miss  Nightingale  and  Crimean  War  1 1 5 

Two  days  later  he  wrote : 

It  is  impossible  for  any  one  to  see  the  melancholy 
sights  of  the  last  few  days  without  feelings  of  surprise 
and  indignation  at  the  deficiencies  of  our  medical 
system.  The  manner  in  which  the  sick  and  wounded 
have  been  treated  is  worthy  only  of  the  savages  of 
Dahomey.  Numbers  arrived  at  Scutari  without 
having  been  touched  by  a  surgeon  since  they  fell, 
pierced  by  Russian  bullets,  on  the  slopes  of  Alma. 
The  ship  was  literally  covered  with  prostrate  forms, 
so  as  to  be  almost  unmanageable.  The  officers  could 
not  get  below  to  find  their  sextants,  and  the  run  was 
made  at  hazards. 

The  worst  cases  were  placed  on  the  upper  deck, 
which,  in  a  day  or  two,  became  a  mass  of  putridity. 
The  neglected  gunshot  wounds  bred  maggots,  which 
crawled  in  every  direction,  infecting  the  food  of  the 
unhappy  beings  on  board.  The  putrid  animal 
matter  caused  such  a  stench  that  the  officers  and 
crew  were  nearly  overcome,  and  the  captain  is  now 
ill  from  the  effects  of  the  five  days  of  misery.  All  the 
blankets,  to  the  number  of  1500,  have  been  thrown 
overboard  as  useless.  There  are  no  dressers  or  nurses 
.  .  .  Their  [the  French]  medical  arrangements  are 
extremely  good  .  .  .  they  have  also  the  help  of  the 
Sisters  of  Charity^  who  have  accompanied  the  expe- 
dition in  incredible  numbers.  We  have  nothing. 
The  men  must  attend  to  each  other  or  receive  no 
relief  at  all.^ 

»  The  Russian  soldiers  were  also  attended  by  Sisters  of 
Mercy.  Mme.  Bakounina,  their  head,  was  called  the  Russian 
Florence  Nightingale.  She  and  her  staff  used  to  go  out  in 
long  boots,  and  carry  in  the  wounded. 

2  Times,  Oct.  13,  1854. 


ii6  A  History  of  Nursing 

Shortly  before  he  had  written : 

The  sick  appeared  to  be  attended  by  the  sick,  and 
the  dying  by  the  dying. 

Indignation  and  pity  swept  through  England, 
and  the  papers  were  full  of  letters  and  calls  for 
assistance.  A  ringing  appeal  for  nurses,  signed 
by  *'  Medicus,  "  in  the  Times,  ^  said :  *'  Why  are  there 
no  female  nurses?  Away  with  this  nonsense 
[rules  of  service]!  there  must  be  female  nurses." 
This  demand  was  echoed  on  all  sides,  and  when 
Russell's  impassioned  appeal  to  the  women  of 
England  was  read,  military  red  tape  was  swept 
away  in  an  outburst  of  public  emotion. 

Are  there  no  devoted  women  among  us  [he  cried], 
able  and  willing  to  go  forth  and  minister  to  the  sick 
and  suffering  soldiers  of  the  East  in  the  hospitals 
at  Scutari?  Are  none  of  the  daughters  of  England, 
at  this  extreme  hour  of  need,  ready  for  such  a  work 
of  mercy?  France  has  sent  forth  her  Sisters  of 
Mercy  unsparingly,  and  they  are  even  now  by  the 
bedsides  of  the  wounded  and  the  dying,  giving  what 
woman's  hand  alone  can  give  of  comfort  and  relief 
in  such  awful  scenes  of  suffering.  Our  soldiers  have 
fought  beside  the  troops  of  France,  certainly  with  no 
inferior  courage  and  devotedness,  in  one  of  the  most 
sanguinary  and  terrific  battles  ever  recorded.  Must 
we  fall  so  far  below  the  French  in  self-sacrifice  and 
devotedness  in  a  work  which  Christ  so  signally 
blesses  as  done  vmto  himself? — "I  was  sick,  and  ye 
visited  Me"?  ^ 

1  Oct.  14. 

2  Tiynes,  Oct.  14. 


Miss  Nightingale  and  Crimean  War  117 

The  response  was  instantaneous.  The  offer 
made  by  St.  John's  House  has  been  mentioned. 
The  Catholic  bishop  of  Southwark  offered  to  send 
Sisters;  there  were  volunteers  from  medical 
students  and,  as  in  later  wars,  enthusiastic  but 
undisciplined  society  women  deluged  the  War 
Office  with  applications.  The  first  practical  steps 
seem  to  have  been  taken  by  Lady  Maria  Forrester, 
the  daughter  of  an  Irish  nobleman,  who  engaged 
three  nurses,  promised  to  pay  their  expenses,  and 
asked  Miss  Nightingale,  on  the  nth  of  October, 
if  she  would  take  them  to  the  Crimea.  Miss 
Nightingale  consented,  and  wrote  her  historic 
letter  asking  if  Mr.  Herbert,  then  Secretary  at 
War,  would  endorse  and  authorise  their  going.  ^ 
She  also  asked  Mrs.  Herbert  (her  personal  friend) 
to  send  word  to  Lady  Stratford,  the  wife  of  the 
British  Ambassador  at  Constantinople,  that  Miss 
Nightingale  was  not  just  a  lady,  but  was  a  hospital 
nurse  with  experience.  2 

The  coincidence  of  this  letter  crossing  one  from 
Mr.  Herbert,  begging  her  to  go  to  the  Crimea,  is 
well  known.  He  offered  her  the  support  and 
backing  of  the  government,  and  assured  her  that 
she  alone  was  capable  of  saving  the  situation, 
saying : 

Would   you   listen   to   the  request   to   go   out   and 

1  Eastern  Hospitals  and  English  Nurses,  by  a  Lady  Volun- 
teer.   Hurst  &  Blackett,  London,  1856.  and  edition,  vol.  i., 

PP-  4-5- 

2  Memoirs  of  Sidney  Herbert,  vol.  i.,  p.  336. 


ii8  A  History  of  Nursing 

supervise  the  whole  thing?  Upon  your  decision 
will  depend  the  ultimate  success  or  failure  of  the  plan. 
Your  own  personal  qualities,  your  knowledge,  your 
power  of  administration,  and  among  greater  things 
your  rank  and  position  in  society  give  you  advantages 
in  such  a  work  which  no  other  person  possesses.^ 

One  week  after  that  time  Miss  Nightingale  had 
her  group  of  nurses  ready  to  start.  She  gives  the 
Hst  as  follows:  lo  Roman  Catholic  nuns,  of  two 
different  orders,  one  cloistered,  one  not;  8  Sisters 
of  Mercy  of  the  Church  of  England,  of  two  dif- 
ferent houses ;  6  nurses  from  St.  John's  Institute ; 
14  nurses  actually  serving  in  different  hospitals; 
Mrs.  Bracebridge,  who  undertook  the  domestic 
management;  Miss  Nightingale,  superintendent. ^ 
Some  of  the  Anglican  Sisters  came  from  Miss 
Sellon's  sisterhood.^ 

The  first  place  to  which  Miss  Nightingale 
turned  to  look  for  nurses  w^as  the  institute  founded 
by  Mrs.  Fry, — but  the  spirit  of  I\lrs.  Fry  must  have 
been  for  the  time  being  absent,  for  the  directors 
were  not  willing  to  accede  to  the  very  necessary 

1  Pincoffs  says  that  this  letter,  which  appeared  in  the 
Daily  News  of  Oct.  25th,  was  given  out  by  an  indiscreet 
friend.  See  Experience  of  a  Civilian  in  Eastern  Military 
Hospitals.  Peter  Pincoffs,  M.D.  Williams  &  Norgate,  Lon- 
don, 1857.  p.  73.  Pollard  gives  it  in  full.  See  Florence 
Nightingale,  by  Eliza  F.  Pollard.  S.  W.  Partridge  Co.,  London, 
1902.     pp.    74-78. 

2  In  Notes  on  the  British  Army,  p.  154. 

3  The  Times  of  Oct.  30  mentions  a  Miss  Erskine,  daughter 
of  a  Welsh  nobleman  as  a  "certificated  nurse"  who  had  gone 
with  Miss  Nightingale, 


Miss  Nightingale  and  Crimean  War  119 

condition  that  the  nurses  should  be  solely  under 
Miss  Nightingale's  authority,  and,  for  the  time 
being,  removed  from  that  of  their  own  home  es- 
tablishment. St.  John's  House  had  at  first  also 
objected  to  this,  but  then  waived  their  objection. 
Miss  Nightingale  left  England  for  the  Crimea  on 
October  21,  1854,  arriving  there  on  Nov.  4,  and 
remained  there  for  nearly  two  years,  or  until 
August  8,  1856,  the  date  of  her  return  to 
England. 

Grateful  recognition  must  ever  be  given  to 
Sidney  Herbert,  for  the  daring  and  firmness  with 
which  he  carried  out  the  then  unheard-of  experi- 
ment of  introducing  gentlewomen  as  nurses  into 
the  military  hospitals.     Kinglake  says : 

He  quietly  yet  boldly  stepped  out  beyond  his  set 
bounds,  and  not  only  became  in  this  hospital  business 
the  volunteer  delegate  of  the  Duke  of  Newcastle, 
but  even  ventured  to  act  without  always  asking  the 
overworked  department  of  war  to  go  through  the 
form  of  supporting  him  by  order  from  the  Secretary 
of  State.  ^ 

The  official  position  which  the  government  had 
given  Miss  Nightingale  was  Superintendent  of 
the  Nursing  Staff  in  the  East,  and  the  title  by 
which  she  eventually  became  known  was  that  of 
the  "  Lady-in-Chief . " 

A  little  book  of  somewhat  questionable  relia- 

1  The  Invasion  of  the  Crimea,  1880,  vol.  vi.,  chapter  xi.,  p. 
409. 


I20  A  History  of  Nursing 

bilityi  quotes  from  the  report  issued  by  Miss 
Nightingale  after  the  war  to  the  donors  of 
voluntar}^  subscriptions,  thus:  that  her  "superin- 
tendence extended  over  the  female  nursing 
establishment  of  the  Barrack  and  General  hos- 
pitals at  Scutari,  of  those  at  Koulalee,  and  of 
five  general  hospitals  in  the  Crimea."  It  seems 
probable,  from  Sidney  Herbert's  letters,  that  her 
supervision  of  the  last -mentioned  hospitals  was, 
at  first,  more  like  that  of  a  sanitary  chief  or 
general  director,  and  not  directly  that  of  an  or- 
ganiser of  nursing,  although  her  authority  as 
niu-sing  head  was  finally  recognised  in  all. 

The  first  and  chief  scene  of  her  labours  was 
the  great  Barrack  hospital  at  Scutari,  which 
had  been  lent  to  the  British  Government  by 
the  Turks.  It  is  an  enormous  square  building, 
three  stories  high  and  whose  corridors  have  a 
total  length  of  four  miles,  and  is  now  restored  to 
its  original  use  as  a  militar}^  barrack.  The  Times 
correspondent  wrote  of  her  arriving  with  her 
ladies,  all  dressed  quietly  in  black,  and  of  the  hope 
inspired  by  the  sight  in  those  who  watched  them 
wend  their  way  up  from  the  shore.  The  con- 
ditions in  and  around  the  hospital  were  such  as 
to  defy  description,  though  Russell,  perhaps 
somewhat    chastened    by    the    military    officials, 

»  Autobiography  of  a  Balaclava  Xiirse,  by  Mrs.  Elizabeth 
Davis,  2  vols.,  London,  1857.  Questionable  because  the 
writer  was  an  illiterate  and  egotistical  person  of  narrow  in- 
telligence, one  of  the  paid  nurses,  who  had  been  a  cook. 


o     ^ 
S      u 


Miss  Nightingale  and  Crimean  War  121 

now  wrote  rather  whitewashing  letters,  saying 
that  the  men  were  "not  uncomfortable"  and  the 
wards  were  "clean. "^  But  after  the  battle  of 
Alma  the  wounded  had  poured  into  the  hospital, 
their  wounds  still  undressed,  their  fractures  not 
set,  and  they  were  half  starved.     It  was  said  that 

There  were  no  vessels  for  water,  or  utensils  of  any 
kind;  no  soap,  towels,  or  hospital  clothes;  the  men 
lying  in  their  uniforms,  stiff  with  gore  and  covered 
with  filth  to  a  degree  and  of  a  kind  no  one  could 
write  about;  their  persons  covered  with  vermin, 
which  crawled  about  the  floors  and  walls  of 
the  dreadful  den  of  dirt,  pestilence,  and  death  to 
which  they  were  consigned.  The  medical  men  toiled 
with  unwearied  assiduity,  but  their  numbers  were 
inadequate. 

This  was  the  scene  on  which  Miss  Nightingale 
entered,  and,  at  the  very  time  of  her  arrival, 
the  wounded  were  again  pouring  into  the  hospital 
by  the  hundred.  The  Rev.  Sydney  Osborne  has 
left  a  graphic  account  of  the  conditions  with 
which  Miss  Nightingale  had  to  grapple  on  her 
arrival  and  of  the  colossal  indifference  of  the 
military  officials: 

I  arrived  at  Constantinople  on  the  eighth  of 
November:  on  that  or  the  following  day  we  heard  of 
the  battle  of  Inkerman,  a  transport  ship  having 
arrived  with  a  large  number  of  the  wounded.  The 
same  day  that  I  arrived,  I  crossed  the  Bosphorus  to 
Scutari,  and  went  to  the  general  hospital,  and  there 
presented  a  letter  from  Mr.  Herbert  to  the  superior 

1  The  Times,  Nov.  i8  and  23,  1854. 


122  A  History  of  Nursing 

medical  officer,  Dr.  Menzies;  he  took  me  round  some 
of  the  wards  of  that  building,  and  to  my  repeated 
offers,  either  from  my  own  or  other  funds,  of  as- 
sistance in  any  way  in  which  it  could  be  afforded  I 
received  the  answer  "they  had  everything — nothing 
was  wanted."  ...  I  was  not  for  one  moment 
deceived  by  the  declaration  of  Dr.  Menzies  that 
nothing  was  wanted;  I  have  had,  as  my  friends  all 
know,  for  many  years  an  intimate  acquaintance 
with  most  matters  relating  to  medical  and  surgical 
practice ;  I  think  I  can  say  with  truth  I  have  followed 
the  study  of  medicine  and  surgery  for  twenty  years 
of  my  life,  with  an  attention  equal  to  that  of  many 
who  do  so  as  a  matter  of  professional  duty — a  hospital 
and  its  requirements  were  no  new  thing  to  me. 

It  would  only  tire  the  general  reader  if  I  were  to 
go,  day  by  day,  into  the  occurrences  which,  following 
in  quick  succession,  soon  proved  to  me,  not  only  that 
these  vast  hospitals  were  absolutely  without  the 
commonest  provision  for  the  exigencies  they  had  to 
meet,  but  that  there  was  in  and  about  the  whole 
sphere  of  action  an  utter  want  of  that  accord  amongst 
the  authorities  in  each  department,  which  alone 
could  secure  any  really  vigorous  effort  to  meet  the 
demands  which  the  carrying  on  of  the  war  was  sure 
to  make  upon  them.  It  is  quite  true  that,  as  ship 
after  ship  brought  down  their  respective  cargoes  of 
wounded  and  sick,  the  medical  and  other  officers, 
with  Miss  Nightingale  and  her  corps  of  nurses,  did 
work  from  morning  till  night  and  through  the  night, 
in  trying  to  meet  the  pressure  upon  their  scanty 
resources;  but  the  whole  thing  was  a  mere  matter  of 
excited,  almost  frenzied  energy,  for  where  so  much 
that  was  necessary  was  absent   it   followed  that  all 


Miss  Nightingale  and  Crimean  War  123 

that  zeal  and  labour  could  effect  was,  by  various 
temporary  expedients,  to  do  that  which  when  done 
was  wholly  inadequate  to  what  was  really  required. 
I  saw  all  the  Balaclava  and  Inkerman  wounded  had 
to  go  through;  I  had  it  from  the  hps  of  the  chief 
actors  in  the  scene  what  the  preparations  were 
which  awaited  the  wounded  of  "Alma."  I  know 
what  the  chaplain  and  officers  had  to  do  then;  the 
"Sisters"  had  not  arrived — there  was  no  Miss  Night- 
ingale with  that  wonderful  power  to  command  help, 
the  quickness  to  see  where  it  would  most  avail.  I 
can  say  with  truth  I  am  glad  I  have  not  that  tale  to 
tell.  And  yet  I  could  not  find  that  anything  had  been 
asked  from  Lord  Redcliffe  even  up  to  the  time  I  saw 
the  hospital  myself.  Why  should  he  have  been  asked 
for  help?  The  chief  authority  was  clearly  under  the 
delusion  that  "nothing  was  wanted."  ...  I  have 
never  seen  any  accounts  yet  that  have  in  their  united 
information  really  given  the  whole  truth  as  it  might 
be  given.  I  cannot  conceive,  as  I  now  calmly  look 
back  on  the  first  three  weeks  after  the  arrival  of  the 
wounded  from  Inkerman,  how  it  could  have  been 
possible  to  have  avoided  a  state  of  things  too  dis- 
astrous to  contemplate  had  not  Miss  Nightingale 
been  there,  and  had  the  means  placed  at  her  disposal 
by  Mr.  Macdonald  [a  special  commissioner  sent  with 
large  funds  by  the  Times.]  I  could  enumerate 
through  a  very  long  list  article  after  article  of  absolute 
necessity,  as  a  part  of  hospital  stores,  which  was 
either  not  in  existence,  or  so  stored  as  to  defy  access 
to  it.  It  was  not  merely  that  with  the  exception  of 
a  ward  here  and  there  there  was  no  appearance  of  the 
order  which  one  would  have  expected  in  a  military 
hospital,  supported  at  an  almost  fabulous  expense; 


124  A  History  of  Nursing 

but  there  was  an  utter  absence  of  the  commonest 
preparation,  to  carry  out  the  very  first  and  simplest 
demands  in  a  place  set  apart  to  receive  the  sick  and 
wounded  of  a  large  army.  ...  I  here  deliberately 
record  my  conviction  that  not  only  was  the  Home 
Government  grossly  deceived  by  the  information  it 
received  from  the  East,  but  that  it  must  have  been 
most  grossh'  betrayed  at  home  by  those  to  whose 
several  departments  the  proper  management  of  the 
details  of  those  hospitals  was  entrusted.  Had  Miss 
Nightingale  and  her  staff  taken  up  their  post  in  the 
best  regulated  hospital  conceivable,  with  four  thousand 
patients,  their  task  would  have  taxed  to  the  utmost 
their  every  energy.  Here  was  an  utter  want  of  all 
regulation;  it  was  a  mere  unseemly  scramble;  the 
staff  was  altogether  deficient  in  strength,  the  com- 
missariat and  purveying  departments  as  weak  in 
power  as  in  capacity;  there  was  no  real  head,  and 
there  existed  on  all  sides  a  state  of  feeling  which  was 
inclined  to  resent  all  non-military  interference; 
whilst  at  the  same  time  it  was  shamefully  obvious 
that  there  was  no  one  feature  of  military  order. 
Jealous  of  each  other,  jealous  of  every  one  else,  with 
some  few  bright  exceptions  there  was  little  encourage- 
ment from  any  of  the  officials  for  any  one  out  of  mere 
benevolence  to  lend  any  aid.  The  fact  is,  the  stout 
denial  of  the  shameful  condition  of  the  hospitals, 
made  to  the  authorities  at  home,  could  not  be  made 
on  the  spot;  the  officials  therefore  walked  about 
self-convicted.  As  a  warm  friend  of  the  government, 
sent  out  under  the  direct  sanction  of  the  War  Office^ 
I  am  satisfied  it  was  the  wish  of  Miss  Nightingale 
to  make  the  best  of  everything.  She  at  once  found 
the  real  truth  and  cheerfully  and  gratefully  availed 


Miss  Nightingale  and  Crimean  War  125 

herself  of  that  help  from  irregular  sources  which  to 
this  moment  has  been  her  chief  support.  ^ 

No  one  at  home  had  a  conception  of  the  total 
absence  of  all  supplies  in  the  hospital.  Sidney 
Herbert,  knowing  that  tons  of  hospital  appliances 
and  thousands  of  sheets  had  been  sent  out,  and 
confident  of  having  foreseen  every  emergency,  had 
assured  Miss  Nightingale  that  she  would  find 
everything  necessary  to  work  with.  But  what 
had  actually  happened  was  that  the  medical 
stores,  for  various  reasons,  had  gone  to  wrong 
ports  or  were  buried  under  shell  and  cannon  in 
the  hold  of  vessels,  while  the  Home  Office  had 
never  been  apprised  of  their  non-arrival  or  non- 
delivery. 

Within  ten  days  after  she  had  landed  Miss 
Nightingale  had  a  kitchen  fitted  up  for  special 
diets,  w^hich  supplied  nourishment  for  nearly 
1000  men,  ^  and  her  next  work  was  to  fit  up  a 
laundry  in  a  private  house  which  she  rented  for 
the  purpose.  Lavish  funds  and  stores  had  been 
placed  at  her  disposal  personally,  and  in  addition 
the  Times  had  raised  a  fund  to  be  administered 
on  the  spot  by  Mr.  Macdonald.  During  the  first 
three  months  Miss  Nightingale  provided  10,000 
shirts  for  the  men,  and  other  necessities  in  pro- 
portion, out  of  her  own  supplies. 

»  Scutari  and  its  Hospitals,  by  the  Hon.  and  Rev.  Sydney 
Godolphine  Osborn.    London,  1855.    PP-  2-25. 

2  The  Story  of  Florence  Nightingale,  by  Wintle.  London, 
no  date.    p.  69. 


126  A  History  of  Nursing 

All  that  official  authority  could  do  to  make  her 
position  an  effective  one  Sidney  Herbert  did. 
The  nurses  had  not  been  asked  for  or  wanted  by 
the  military  heads  at  Scutari,  and  although,  as 
was  to  be  understood.  Miss  Nightingale  and  her 
nurses  were  to  work  "in  strict  subordination  to 
the  medical  officers,"^  it  seems  quite  evident  that 
this  was  meant  to  apply  to  the  medical  orders 
only.  Had  she  been  reduced  to  the  necessity 
of  obeying  "regulations"  all  reformation  would 
have  been  impossible.  That  she  had  large,  and 
in  some  directions  unhampered,  powers  to  re- 
generate, to  improve,  and  to  advise  seems  plain. 
Kinglake  says  that  the  letters  sent  from  the 
War  Office  to  Scutari,  though  tactfully  sparing 
the  feelings  of  those  in  authority,  made  it  quite 
plain  that  Miss  Nightingale  had  the  government 
behind  her,  and  adds: 

Most  happily  this  gifted  minister  [Herbert]  had 
formed  a  strong  belief  in  the  advantages  our  military 
hospitals  would  gain  by  accepting  womanly  aid,  .  .  . 
and  .  .  .  whilst  requesting  the  principal  medical 
officer  at  Scutari  to  point  out  to  these  new  auxiliaries 
how  best  they  could  make  themselves  useful,  Mr. 
Sidney  Herbert  enjoined  him  to  receive  with  attention 
and  deference  the  counsels  of  the  Lady-in-Chief.^ 

Probably  at  no  time  in  the  history  of  war 
nursing  has  an  irresistible  public  opinion  forced 
upon   an  unwilling  military  hierarchy  a  lady-in- 

«  Letter  by  Sidney  Herbert,  Times,  Oct.  24. 
^Op.  cit.,  vol.  vi.,  chap,  xi.,  p.  410. 


Miss  Nightingale  and  Crimean  War  127 

chief  with  such  extensive  authority,  such  dis- 
cretionary powers,  and  well  understood,  though 
confidential,  relations  with  the  War  Office.  The 
fact  that  this  was  the  first  time  in  the  history  of 
civilised  nations  (or,  so  far  as  we  know,  of  the 
world)  that  a  nurse  had  been  put  into  such  a 
position  makes  it  especially  interesting  to  hear 
what  those  who  were  personal  witnesses  of  her 
actions  in  this  post  of  unexampled  diffictdty  have 
to  say  of  her.  The  Rev.  Mr.  Osborne  has  left 
this  description  of  her: 

Miss  Nightingale  in  appearance  is  just  what  you 
would  expect  in  any  other  well-bred  woman  who 
may  have  seen  perhaps  rather  more  than  thirty  years 
of  life;  her  manner  and  countenance  are  prepossess- 
ing, and  this  without  the  possession  of  positive  beauty: 
it  is  a  face  not  easily  forgotten,  pleasing  in  its  smile, 
with  an  eye  betokening  great  self-possession,  and  giv- 
ing, when  she  wishes,  a  quiet  look  of  firm  determination 
to  every  feature.  Her  general  demeanour  is  quiet  and 
rather  reserved ;  still  I  am  much  mistaken  if  she  is  not 
gifted  with  a  very  lively  sense  of  the  ridiculous.  In 
conversation,  she  speaks  on  matters  of  business  with 
a  grave  earnestness  one  would  not  expect  from  her 
appearance.  She  has  evidently  a  mind  disciplined 
to  restrain  under  the  principles  of  the  action  of  the 
moment  every  feeling  which  would  interfere  with  it. 
She  has  trained  herself  to  command  and  learned  the 
value  of  conciliation  towards  others,  and  constraint 
over  herself.  I  can  conceive  her  to  be  a  strict  dis- 
ciplinarian; she  throws  herself  into  a  work  as  its 
head — as   such   she   knows   well   how   much   success 


128  A  History  of  Nursing 

must  depend  upon  literal  obedience  to  her  every 
order.  She  seems  to  understand  business  thoroughly, 
though  to  me  she  had  the  failure  common  to  many 
"heads, "  a  too  great  love  of  management  in  the  small 
details  which  had  better  perhaps  have  been  left  to 
others.  Her  nerve  is  wonderful;  I  have  been  with 
her  at  very  severe  operations;  she  was  more  than 
equal  to  the  trial.  She  has  an  utter  disregard  of 
contagion;  I  have  known  her  spend  hours  over  men 
dying  of  cholera,  or  fever.  The  more  awful  to  every 
sense  any  particular  case,  especially  if  it  was  that  of  a 
dying  man,  her  slight  form  would  be  seen  bending 
over  him,  administering  to  his  ease  in  every  way 
in  her  power,  and  seldom  quitting  his  side  until  death 
released    him.^ 

Soyer,  the  French  chef,  who  offered  his  services 
in  the  hospitals  of  the  Crimea,  and  whose  enter- 
taining book  is  full  of  homely  daily  allusions  to 
Miss  Nightingale  as  he  saw  her  going  about  her 
work,  describes  her  with  French  vivacity  thus : 

She  is  rather  high  in  stature,  fair  in  complexion,  and 
slim  in  person;  her  physiognomy  is  most  pleasing; 
her  eyes,  of  a  bluish  tint,  speak  volumes,  and  are 
always  sparkling  with  intelligence ;  her  mouth  is  small 
and  well  formed,  while  her  lips  act  in  unison,  and 
make  known  the  impression  of  her  heart — one  seems 
the  reflex  of  the  other.  Her  visage,  as  regards  ex- 
pression, is  very  remarkable  and  one  can  almost 
anticipate  by  it  what  she  is  about  to  say:  alternately 
with  matters  of  the  most  grave  import,  a  gentle  smile 
passes  radiantly  over  her  countenance,  thus  proving 

»  Scutari  and  its  Hospitals,  pp.   25-26. 


Miss  Nightingale  and  Crimean  War  129 

her  evenness  of  temper.  At  other  times,  when 
wit  or  a  pleasantry  prevails,  the  heroine  is  lost  in 
the  happy,  good-natured  smile  which  pervades  her 
face,  and  you  recognise  only  the  charming  woman. 
Her  dress  is  generally  of  a  greyish  or  black  tint ;  she 
wears  a  simple  white  cap,  and  often  a  rough  apron. 
In  a  word,  her  whole  appearance  is  reHgiously  simple 
and  unsophisticated.  In  conversation  no  member 
of  the  fair  sex  can  be  more  amiable  and  gentle  than 
Miss  Nightingale.  Removed  from  her  arduous  and 
cavalier-like  duties,  which  require  the  nerve  of  a 
Hercules — and  she  possesses  it  w^hen  required — she  is 
Rachel  on  the  stage  in  both  tragedy  and  comedy.^ 

Macdonald,  the  Times  commissioner,  after  his 
return  to  England  said  of  her: 

Wherever  there  is  disease  in  its  most  dangerous 
form,  and  the  hand  of  the  spoiler  distressingly  nigh, 
there  is  that  incomparable  woman  sure  to  be  seen; 
her  benignant  presence  is  an  influence  for  good  com- 
fort, even  among  the  struggles  of  expiring  nature. 
She  is  a  "ministering  angel,"  without  any  exaggera- 
tion, in  these  hospitals,  and  as  her  slender  form  glides 
quietly  along  each  corridor  every  poor  fellow's  face 
softens  with  gratitude  at  the  sight  of  her.  When  all 
the  medical  officers  have  retired  for  the  night,  and 
silence  and  darkness  have  settled  down  upon  those 
miles  of  prostrate  sick,  she  may  be  observed  alone, 
with  a  little  lamp  in  her  hand,  making  her  soHtary 
rounds.  The  popular  instinct  was  not  mistaken, 
which,  when  she  had  set  out  from  England  on  her 
mission  of  mercy,  hailed  her  as  a  heroine;  I  trust  she 

»  Soyer's  Culinary  Campaign,  Alexis  Soyer.  G.  Routledge, 
London,  1857.    pp.  153-154. 

VOL.  II. 9 


I30  A  History  of  Nursing 

may  not  earn  her  title  to  a  higher  though  sadder 
appellation.  No  one  who  has  observed  her  fragile 
figure  and  delicate  health  can  avoid  misgivings  lest 
these  should  fail.  AVith  the  heart  of  a  true  woman, 
and  the  manners  of  a  lady,  accomplished  and  refined 
beyond  most  of  her  sex,  she  combines  a  surprising 
calmness  of  judgment  and  promptitude  and  decision 
of  character.  ^ 

Ingleby  Scott  draws  attention  to  two  qualities 
of  mind  which  no  doubt  might  have  affronted 
egotistical  natures: 

She  was  never  resorted  to  for  sentiment.  Senti- 
mentalists never  had  a  chance  with  her.  Besides  that 
her  character  was  too  strong,  and  its  qualities  too 
real,  for  any  sympathy  with  shallowness  and  egotism, 
she  had  two  characteristics  which  might  well  daunt 
the  sentimentalists — her  reserve,  and  her  capacity 
for  ridicule  .  .  .  ;  and  there  is  perhaps  nothing  ut- 
tered by  her,  from  her  evidence  before  the  Sanitary 
Commission  for  the  Army  to  her  recently-published 
Notes  on  Nursing,  which  does  not  disclose  powers  of 
irony  which  self-regardant  persons  may  well  dread. 
.  .  .  The  intense  and  exquisite  humanity  to  the  sick, 
underlying  the  glorious  common-sense  about  affairs, 
and  the  stern  insight  into  the  weaknesses  and  per- 
versions of  the  healthy  .  .  .  lay  open  a  good  deal 
of  the  secret  of  this  wonderful  woman's  life  and 
power.  .  .  .  We  see  how  her  minute  economy  and 
attention  to  the  smallest  details  are  reconcilable 
with  the  magnitude  of  her  administration,  and  the 
comprehensiveness  of  her  plans  for  hospital  establish- 

1  Wintle,   op.  cit.,  p.  97. 


Miss  Nightingale  and  Crimean  War  131 

ments,  and  for  the  reduction  of  the  national  rate  of 
mortality.  As  the  lives  of  the  sick  hang  on  small 
things,  she  is  as  earnest  about  the  quality  of  a  cup  of 
arrowroot,  and  the  opening  and  shutting  of  doors, 
as  about  the  institution  of  a  service  between  the 
commissariat  and  the  regimental,  which  shall  insure 
an  army  against  being  starved  when  within  reach  of 
food.  In  the  mind  of  a  true  nurse  nothing  is  too 
great  or  too  small  to  be  attended  to  with  all  diligence ; 
and  therefore  we  have  seen  Florence  Nightingale 
doing  and  insisting  upon  the  right  about  shirts  and 
towels,  spoon-meats,  and  the  boiling  of  rice,  and 
largely  aiding  in  reducing  the  mortality  of  the  army 
from  nineteen  in  the  thousand  to  eight,  in  times  of 
peace.  .  .  .  Except  for  the  purpose  of  direct  utility 
she  never  speaks  of  herself  or  even  discloses  any  of 
her  opinions,  views,  or  feelings.  This  reserve  is  a 
great  distinction  in  these  days  of  self-exposure  and 
descanting  on  personal  experience.^ 

Even  more  discerning  and  graphic  is  Kinglake, 
who  sets  off  his  study  of  Miss  Nightingale,  to 
whom  he  devotes  an  entire  chapter,  with  a  recur- 
ring refrain  of  ironic  *'  motif"  against  the  *'  males." 
All  the  women,  he  says,  were  devoted ;  but 

there  was  one  of  them — the  Lady-in-Chief — who  not 
only  came  armed  with  the  special  experience  needed, 
but  also  was  clearly  transcendent  in  that  subtle 
quality  which  gives  to  one  human  being  a  power  of 
command  over  others.  Of  slender,  delicate  form, 
engaging,  highly  bred,  in  council  a  rapt,  careful 
listener  as  long  as  others  were  speaking,  and  strongly 

>  Ingleby  Scott,  op.  cit.,  pp.  1-3. 


132  A  History  of  Nursing 

though  gently  persuasive  whenever  speaking — the 
Lady-in-Chief  gave  her  heart  to  this  enterprise  in  a 
spirit  of  absolute  devotion,  but  her  sway  was  not 
quite  of  the  kind  that  many  in  England  imagined. 
.  .  .  None  knew  better  than  she  did  that  if  kind, 
devoted  attention  will  suffice  to  comfort  one  sufferer, 
it  is  powerless  to  benefit  those  who  number  thousands, 
unless  reinforced  by  method,  organisation,  by  disci- 
pline; .  .  .  far  from  being  a  spumer  of  rules,  she  had 
so  deep  a  sense  of  their  worth  as  to  be  seemingly 
much  more  in  danger  of  being  too  strict  than  too  lax. 
Her  detractors  said  that  "the  soundness  of  judgment 
disclosed  by  the  Lady-in-Chief  upon  questions  needing 
rapid  decision,  and  the  apt,  ready  knowledge  with 
which  she  always  seemed  armed,  might  be  traced  to 
the  power  she  had  over  men  in  authority ' ' ;  the  theory 
being,  it  seems,  that  because  they  felt  her  ascendent, 
these  officials  were  always  longing  to  give  her  the  very 
choicest  and  best  of  their  facts  and  ideas.  But  a 
simpler  explanation  of  the  abundant  mental  resource, 
at  which  people  w^ondered,  might  be  found  in  the  keen 
discrimination  enabling  her  to  judge  at  the  instant 
whether  any  of  the  words  addressed  to  her  should  be 
treasured  or  set  at  naught. 

And  besides  that  her  perfect  knowledge  of  hos- 
pital business  and  how  to  conduct  it : 

However  originating,  the  gift  without  which  she 
could  never  have  achieved  what  she  did  was  her  fac- 
ulty of  conquering  dominion  over  the  minds  of  men; 
and  this,  after  all,  was  the  force  which  lifted  her  from 
out  the  ranks  of  those  who  were  only  "able"  to  the 
height  reached  by  those  who  are  called  "great. "... 
The  will  of  the  males  was  always  to  go  on  performing 


Miss  Nightingale  and  Crimean  War  133 

their  accustomed  duties — if  need  be,  even  to  death 
— in  that  groove-going  state  of  Hfe.  .  .  .  The  will  of 
the  woman,  while  stronger,  flew  also  more  straight 
to  the  end ;  for  what  she  almost  fiercely  sought  was 
.  .  .  not  to  make  good  mere  equations  between  official 
codes  of  duty  and  official  acts  of  obedience,  but, 
overcoming  all  obstacles,  to  succour,  to  save  our 
prostrate  soldiery,  and  turn  into  a  well-ordered 
hospital  the  hell — the  appalling  hell — of  the  vast 
barrack  wards  and  corridors.  Nature  seemed,  as 
it  were,  to  ordain  that  in  such  a  conjuncture  the  all- 
essential  power  which  our  cramped,  over-disciplined 
males  had  chosen  to  leave  unexerted  should  pass  to 
one  who  could  seize  it,  should  pass  to  one  who  could 
wield  it, — should  pass  to  the  Lady-in-Chief.^ 

Mi  .^  Macdonald,  the  Times  commissioner,  finding 
that  ''nothing  was  wanted"  by  the  army  officials, 
now  turned  to  Miss  Nightingale  and  worked  in 
conjunction  with  her.  She  had  with  her  her 
friends  Mr.  and  Mrs.  Bracebridge,  the  latter  of 
whom  undertook  the  housekeeping,  and  an  as- 
sistant whom  we  may  well  believe  to  have  been 
invaluable  was  a  young  man  who  came  out  from 
London  to  "fag"  for  her,  writing  letters,  running 

1  Kinglake,  op.  cit.,  vol.  vi.,  pp.  419-424.  Interesting 
notes  are  also  to  be  found  in  the  French  histories  of  the 
war:  "This  frail  young  woman,  who  was  seen  going  on 
horseback  from  one  hospital  to  another,  embraced  in  her 
solicitude  the  sick  of  three  armies. "  La  Guerre  de  Crim-ee, 
M.  L.  Baudens,  1858,  p.  104.  "There,  to  care  for  them, 
a  young  woman,  beautiful,  rich,  intelligent,  of  infinite 
merit  and  rare  distinction.  Miss  Florence  Nightingale,  had 
left  family,  friends,  and  home.  "  Histoire  de  la  Guerre  de 
Crimee,  Camille  Rousset,  1877,  vol.  ii.,  p.  13. 


134  A  History  of  Nursing 

errands,  and  making  himself  generally  useful.  ^ 
On  arrival  they  took  up  their  quarters  in  the  fa- 
mous tower  and  the  niu-ses  were  appointed  to 
their  divisions. 

Let  us  now  follow  the  narrative  of  one  of  the 
nurses  as  told  by  herself: 

We  landed  at  the  wharf,  and  climbing  the  steep 
hill  found  ourselves  at  the  main  guard  or  principal 
entrance  to  Scutari  Barrack  hospital.  The  hospital 
is  an  immense  square  building;  three  long  corridors 
run  completely  round  it,  and  it  is  three  stories  high. 
Numberless  apartments  open  out  of  all  these  corridors, 
which  are  called  wards.  At  each  comer  of  the  build- 
ing is  a  tower.  The  main  guard  divides  A  corridor; 
turning  to  the  left,  after  passing  through  one  or  two 
divisions  from  which  the  guard  rooms  open,  we  came 
to  the  sick. 

To  avoid  the  cold  air  of  the  long  corridor,  wooden 
partitions  were  put  up,  and  the  spaces  between  these 
were  called  divisions.  We  made  our  way  through 
the  double  row  of  sick  to  the  tower  at  the  comer 
(Miss  Nightingale's  quarters) ;  the  smell  in  this  cor- 
ridor of  sick  was  quite  overpowering.   .   .   . 

On  arriving  in  Miss  Nightingale's  quarters  we 
entered  the  large  kitchen  or  hall,  from  which  all  the 
other  rooms  opened.  There  were  four  rooms  on  the 
lower  story,  occupied  as  follows:  Mr.  and  Mrs.  Brace- 
bridge  in  one;  Miss  Nightingale  in  another;  the  five 
nuns  in  the  third ;  fourteen  nurses  and  one  lady  in  the 
last.  A  staircase  led  up  the  tower  to  two  other  rooms ; 
the  first  occupied  by  the  Sisters  from  Miss  Sellon's 
and  other  ladies,  the  second  by  the  nurses  belonging 
»  Kinglake,  op.  cit. 


Miss  Nightingale  and  Crimean  War  135 

to  St.  John's  training  institution.  The  kitchen  was 
used  as  Miss  Nightingale's  extra-diet  kitchen.  From 
this  room  were  discributed  quantities  of  arrowroot, 
sago,  rice  puddings,  jelly,  beef-tea,  and  lemonade, 
upon  requisitions  made  by  the  surgeons.  This 
caused  great  comings  to  and  fro;  numbers  of  orderlies 
were  waiting  at  the  door  with  requisitions.  One  of 
the  nuns  or  a  lady  received  them,  and  saw  they 
were  signed  and  countersigned,  and  then  served 
them. 

We  used,  among  ourselves,  to  call  this  kitchen 
the  tower  of  Babel,  from  the  variety  of  languages 
spoken  in  it  and  the  confusion.  In  fact,  in  the  middle 
of  the  day  everything  and  everybody  seemed  to  be 
there:  boxes,  parcels,  bundles  of  sheets,  shirts,  and 
i)ld  linen  and  flannels,  tubs  of  butter,  sugar,  bread, 
kettles,  saucepans,  heaps  of  books,  and  of  all  kinds 
of  rubbish,  besides  the  diets  which  were  being  dis- 
pensed ;  then  the  people,  ladies,  nuns,  nurses,  orderhes, 
Turks,  Greeks,  French,  and  ItaHan  servants,  officers 
and  others  waiting  to  see  Miss  Nightingale;  all 
passing  to  and  fro,  all  intent  upon  their  own  business, 
and  all  speaking  their  own  language.  ^ 

Mr.  Osborne  has  also  left  a  lively  description 
of  the  nurses'  tower: 

Whatever  of  neglect  may  attach  elsewhere,  none 
can  be  imputed  here.  From  this  tower  flowed  that 
well  -  directed  stream  of  untiring  benevolence  and 
charitable  exertion  which   has   been  deservedly  the 

>  Eastern  Hospitals  and  English  Nurses,  by  a  Lady  Volun- 
teer. London,  1856,  vol.  i.,  pp.  66-69.  This  lady  was  one  of 
the  second  party. 


136  A  History  of  Nursing 

theme  of  so  much  praise.  Here  there  has  been  no 
idleness,  no  standing  still,  no  waiting  for  orders 
from  home,  no  quibbling  with  any  requisition  made 
upon  those  who  so  cheerfully  administered  the  stores 
at    their    disposal. 

Entering  the  door  into  the  "Sisters"  tower,  you 
at  once  found  yourself  a  spectator  of  a  busy  and 
most  interesting  scene.  ...  In  the  further  comer, 
on  the  right-hand  side,  was  the  entrance  to  the  sitting- 
room  occupied  by  Miss  Nightingale  and  her  friends 
the  Bracebridges.  I  shall  ever  recall  with  the  live- 
liest satisfaction  the  many  visits  I  paid  to  this  apart- 
ment. Here  were  held  those  councils  over  which 
Miss  Nightingale  so  ably  presided,  at  which  were 
discussed  the  measures  necessary  to  meet  the  daily 
varying  exigencies  of  the  hospitals.  From  hence 
U'ere  given  the  orders  which  regulated  the  female 
staff,  working  under  this  most  gifted  head.  This 
too  was  the  office  from  which  were  sent  those  many 
letters  to  the  government,  to  friends  and  supporters 
at  home,  which  told  such  awful  tales  of  the  sufferings 
of  the  sick  and  wounded,  their  utter  want  of  so  many 
necessities.  Here  might  be  seen  the  Times  almoner, 
taking  down  in  his  note-book  from  day  to  day  the 
list  of  things  he  was  pressed  to  obtain  which  might  all 
with  a  little  activity  have  been  provided  as  easily  by 
the  authorities  of  the  hospital. 

To  attempt  the  narration  of  the  business  trans- 
acted in  this  room  would  be  a  task  beyond  my  powers. 
It  was  of  a  nature  comprehending  somewhat  of  the 
detail  of  every  recognised  "department";  it  embraced 
the  consideration  of  every  failure  of  duty  on  the  part 
of  "authorities"  at  home  and  on  the  spot;  it  aimed 
at  the  attainment  of  order  and  humanitv  bv  limited 


Miss  Nightingale  and  Crimean  War  137 

means,   to   be   directed   against   the   widest   possible 
field  of  disorganisation.^ 

Let  us  continue  the  narrative  of  the  Lady 
Volunteer : 

Two  days  after  my  arrival,  Miss  Nightingale  sent 
for  me  to  go  with  her  round  the  hospital.  (Miss 
Nightingale  generally  visited  her  special  cases  at 
night.)  We  went  round  the  whole  of  the  second 
story,  into  many  of  the  wards  and  into  one  of  the 
upper  corridors.  It  seemed  an  endless  walk,  and  it 
was  one  not  easily  forgotten.  As  we  slowly  passed 
along  the  silence  was  profound;  very  seldom  did  a 
moan  or  cry  from  those  multitudes  of  deeply  suf- 
fering ones  fall  on  our  ears.  A  dim  light  burned  here 
and  there.  Miss  Nightingale  carried  her  lantern, 
which  she  would  set  down  before  she  bent  over  any  of 
the  patients.  I  much  admired  Miss  Nightingale's 
manner  to  the  men — it  was  so  tender  and  kind. 

All  the  corridors  were  thickly  lined  with  beds 
laid  on  low  trestles  raised  a  few  inches  from  the 
ground.  In  the  wards  a  divan  runs  round  the  room, 
and  on  this  were  laid  the  straw  beds,  and  the  sufferers 
on  them.  The  hospital  was  crowded  to  its  fullest 
extent.  The  building  has  since  been  reckoned  to 
hold  with  comfort  seventeen  hundred  men;  it  then 
held  between  three  and  four  thousand.  Miss  Night- 
ingale assigned  me  my  work — it  was  half  A  corridor, 
the  whole  of  B,  half  C,  the  whole  of  I  (on  the  third 
story),  and  all  the  wards  leading  out  of  these  respec- 
tive corridors;  in  each  corridor  there  were  fifteen  of 
these,  except  in  No.  I,  where  there  were  only  six. 
This  work  I  was  to  share  with  another  lady  and  one 
^Scutari  and  its  Hospitals,  pp.  23-24. 


138  A  History  of  Nursing 

nurse.  The  number  of  patients  under  our  charge 
was,  as  far  as  I  could  reckon,  about  fifteen  hundred. 

Miss  Nightingale  told  us  only  to  attend  to  those 
in  the  divisions  of  those  surgeons  who  wished  for  our 
services.  She  said  the  staff  surgeon  of  the  division 
was  willing  we  should  work  under  him,  and  she 
charged  us  never  to  do  anything  for  the  patients 
without  the  leave  of  the  doctors.   .   .   . 

It  seems  simply  impossible  to  describe  Scutari 
hospital  at  this  time.  Far  abler  pens  have  tried 
and  all  in  some  measure  failed;  for  what  an  eye- 
witness saw  was  past  description.  Even  those  who 
read  the  harrowing  accounts  in  the  Times  and 
elsewhere  could  not  have  imagined  the  full  horror  of 
the  reality.  As  we  passed  the  corridors  we  asked 
ourselves  if  it  was  a  terrible  dream.  When  we  woke 
in  the  morning,  our  hearts  sank  down  at  the  thought 
of  the  woe  we  must  witness  that  day.  At  night  we 
lay  down  wearied  beyond  expression ;  but  not  so  much 
from  physical  fatigue,  though  that  was  great,  as 
from  the  sickness  of  heart  from  living  amidst  that 
mass  of  hopeless  suffering.  On  all  sides  prevailed 
the  utmost  confusion;  whose  fault  it  was  I  cannot 
tell — clear  heads  have  tried  to  discover  in  vain: 
probably  the  blame  should  have  been  shared  by  all 
the  departments  of  the  hospital.   .   .   . 

We  could  not  get  the  assistant  surgeons  to  w^rite 
out  the  number  of  the  requisitions  which  were 
necessary  in  order  to  procure  these  materials.  At 
last  some  of  us  persuaded  one  or  two  of  our  surgeons 
to  write  a  requisition  for  dry  stores;  that  is,  for  tins 
of  preserved  beef-tea,  and  for  lemons  and  sugar  to 
make  lemonade.  .  .  .  One  difficulty  only  remained. 
i.  e.,  hot  water.     It  was  of  course  necessary  to  make 


Miss  Nightingale  and  Crimean  War  139 

the  beef-tea,  and  also  for  the  lemonade,  as  the  water 
was  so  unwholesome  it  could  not  be  used  without 
boiling.  We  contrived  to  boil  water  in  small  quanti- 
ties on  the  stoves  in  the  corridors  and  wards.  It 
was  a  slow  process,  but  still  we  succeeded.   .  .  . 

Our  plan  of  thus  helping  the  men  was  put  a  stop 
to  by  an  order  from  Dr.  Gumming,  the  inspector- 
general,  that  no  cooking  was  to  be  done  in  the  wards, 
and  thus  our  only  means  of  assisting  the  men  was 
ended. 

We  seldom  dressed  the  wounds,  as  there  were 
dressers  who  performed  this  office,  and  the  greater 
number  of  patients  were  cases  of  fever  and  dysentery, 
who  needed  constant  attention  and  nourishment, 
frequently  administered,  in  small  quantities,  and  this 
we  were  now  not  suffered  to  give.  All  the  diets  not 
issued  from  Miss  Nightingale's  kitchen  were  of  such  a 
bad  quality,  and  so  wretchedly  cooked,  that  the  men 
often  could  not  eat  them.  After  a  man  had  been  put 
on  half  or  even  full  diet,  the  surgeons  were  often 
obliged  to  return  him  to  spoon  diet  from  his  not  being 
able  to  eat  the  meat. 

It  was  very  hard  work  after  Dr.  Cumming's  or- 
der had  been  issued  to  pace  the  corridor  and  hear 
perhaps  the  low  voice  of  a  fever  patient,  "Give  me  a 
drink  for  the  love  of  God! "  and  have  none  to  give — 
for  water  we  dared  not  give  to  any ;  or  to  see  the  look 
of  disappointment  on  the  faces  of  those  to  whom 
we  had  been  accustomed  to  give  the  beef-tea.  The 
assistant  surgeons  were  very  sorry,  they  said,  for 
the  alteration  but  they  had  no  power  to  help  it — their 
duty  was  only  to  obey.  On  one  occasion  an  assistant 
surgeon  told  us  that  Dr.  Gumming  had  threatened 
to  arrest  him  for  having  allowed  a  man  too  many 


I40  A  History  of  Nursing 

extras  on  the  diet  roll.  Amid  all  the  confusion  and 
distress  of  Scutari  hospital,  military  discipline  was 
never  lost  sight  of,  and  an  infringement  of  one  of  its 
smallest  observances  was  worse  than  letting  twenty 
men  die  from  neglect.  .  .  .  The  want  of  clean  linen 
was  bitterly  felt  at  that  time  in  Scutari.  How  it  was 
issued  from  the  stores  was  a  mystery  no  one  could  ever 
unravel.  If  things  were  sent  to  be  washed  they  never 
returned,  and  there  was  not  the  slightest  order  or 
regularity  in  the  issue  of  linen,  either  sheets  or  shirts. 
Towels  and  pocket-handkerchiefs  were  both  considered 
unnecessary  luxuries  for  the  soldiers,  and  could  be 
obtained  only  from  Miss  Nightingale's  free-gift  store, 
and,  generally  speaking,  only  from  them  could  flan- 
nel shirts  be  had.   .   .   . 

Confusion,  indeed,  so  prevailed  in  all  quarters  at 
that  unhappy  time  that  though  quantities  of  things 
were  sent  to  Scutari  but  few  ever  reached  the  sufferers 
for  whom  they  were  destined.  Every  ship  that  came 
in  brought  to  ^liss  Nightingale  large  packages  of  every 
imaginable  article  of  wearing  apparel.  ...  It  was 
a  common  thing  to  find  men  with  sheets  and  shirts 
unchanged  for  weeks.  I  have  opened  a  collar  of  a 
patient's  shirt  and  found  it  literally  lined  with 
vermin.  It  was  common  to  find  men  covered  with 
sores  from  lying  in  one  position  on  the  hard  straw 
beds  and  coarse  sheets,  and  there  were  no  pillows  to 
put  under  them.   .   .   . 

A  great  deal  of  sickness  prevailed  among  ourselves ; 
two  nurses  at  this  time  were  lying  ill  with  fever,  one 
not  expected  to  live ;  two  of  the  five  nuns  were  in  the 
same  state — they  both  lay  for  days  at  the  point  of 
death,  but  ultimately  recovered.  During  the  whole 
of  their  illness  they  remained  in  the  room  where  the 


Miss  Nightingale  and  Crimean  War  141 

three  other  Sisters  slept  and  ate.  There  was  no 
infirmary  to  remove  the  sick  ladies  to.  The  sick 
nurses  were  taken  to  a  room  outside  the  hospital.  Of 
course  among  ladies  and  nurses  not  ill  with  fever 
many  were  laid  up  for  a  day  or  two  at  a  time  from  over- 
fatigue and  want  of  proper  food. 

Our  life  was  a  laborious  one :  we  had  to  sweep  our 
own  rooms,  make  our  beds,  wash  up  our  dishes,  etc. ; 
and  fetch  our  meals  from  the  kitchen  below.  We 
went  to  our  wards  at  nine,  returned  at  two,  went  up 
at  three  (unless  we  went  out  for  a  walk,  which  we  had 
permission  to  do  at  this  hour),  returned  at  half-past 
five  to  tea,  then  to  the  wards  again  till  half-past 
nine,  and  often  again  for  an  hour  to  our  special  cases. 
.  .  .  We  suffered  greatly  for  want  of  proper  food. 
Our  diet  consisted  of  the  coarse  sour  bread  of  the 
country,  tea  without  milk,  b'utter  so  rancid  we  could 
not  touch  it,  and  very  bad  meat  and  porter;  and  at 
night  a  glass  of  wine  or  brandy.  .  .  . 

The  quantity  of  vermin  in  the  wards  was  past 
conception;  the  men's  clothes  and  beds  swarmed 
with  them,  so  did  every  room  in  the  hospital.  Our 
clothes  had  their  full  share,  and  the  misery  they 
caused  us  was  very  great;  we  never  slept  more  than 
an  hour  at  a  time  because  of  them.  ^ 

By  Christmas-time  cleanliness,  order,  suitable 
food  and  clothing  had  transformed  the  wards  of 
the  General  and  the  Barrack  hospitals ;  but,  though 
easy-going  critics  now  pronounced  them  to  be  in 
perfect  condition,  Miss  Nightingale  was  burdened 
with  the  heaviest  anxiety,  for  the  state  of  the 

»  Eastern  Hospitals,  etc.,  vol.  i.,  pp.  69-94. 


142  A  History  of  Nursing 

buildings  as  regards  arrangements  for  the  dispo- 
sal of  sewage  was  so  hideous  that  it  can  only  be 
described  in  technicalities.  There  was,  in  fact, 
no  drainage,  no  plumbing;  there  were  almost  no 
sanitary  conveniences.  It  had  all  been  known  in 
time  to  have  been  remedied.  It  was  not  remedied, 
and  the  patients  sent  to  the  hospitals  were  sent  to 
death  traps.  Miss  Nightingale  states:  "The 
deaths  on  cases  treated  were  no  less  than  315  per 
1000,  or  nearly  one  in  three."  ^ 

It  was  the  knowledge  of  this  criminal  neglect, 
this  official  murder,  that  compelled  ^liss  Nightin- 
gale to  war  single-handed,  except  for  Sidney  Her- 
bert's support,  against  the  bureaucracy  of  the 
army  medical,  sanitar^^  and  engineering  staffs. 
It  was  her  urgent  reports  and  her  itemised  state- 
ments and  demands,  says  Kinglake,  that  finally 
brought  about  the  undertaking  of  extensive 
sanitary  engineering  works,  which  were  completed 
in  Jime,  1855,  when  the  death  rate  fell  to  "22  per 
1000  on  cases  treated"  (Miss  Nightingale's  words), 
and  he  hints  strongly  that  even  in  the  very  word- 
ing of  the  directions  which  came  out  from  the 
War  Office,  and  especially  in  the  mandates  to 
speed  and  celerity,  there  was  a  minuteness  of 
detail  which  suggested  the  personal  share  of  the 
Lady-in-Chief  therein. 

1  Notes  on  blatters  affecting  the  Health,  Efficieyicy,  and 
Hospital  Administration  of  the  British  Army,  by  Florence 
Nightingale.  Presented  by  Request  to  the  Secrelary  of 
State  for  War.  Harrison  &  Sons,  London,  1858.  Preface, 
sec.  I,  p.  xxvi. 


Miss  Nightingale  and  Crimean  War  143 

This  tragic  winter  of  1854-55  saw  what  Kinglake 
calls  an  interesting  trial  of  brain  powder  and  speed 
between  the  woman  at  work  and  the  "males"  in 
power.  At  the  same  time  that  the  nurses  sailed 
Parliament  appointed  a  commission  to  go  out  to 
the  Crimea  and  investigate  the  conditions.  With 
the  greatest  celerity  in  transportation,  and  al- 
lowing for  no  delays,  it  could  only  have  reported 
back  to  Parliament  in  thirteen  wrecks,  whereas 
by  Christmas  Miss  Nightingale  had  a  fairly  good 
system  running.  The  commission  set  forth  with 
no  powers  to  do  aught  but  report,  but  acting  on  a 
letter  from  Miss  Nightingale  Sidney  Herbert  wrote 
to  them  to  take  steps  on  the  spot  to  have  defi- 
ciencies corrected.  They  only  received  this  order 
in  time  to  begin  making  recommendations  on  the 
22  nd  or  23rd  of  January — and  this  for  the  troops 
only;  their  report  from  Scutari  was  forwarded 
about  the  23rd  of  February,  reaching  London 
about  the  29th  of  March,  in  time  for  the  ministers 
to  get  their  orders  out  for  the  late  spring,  three  or 
four  months  (sa3^s  Kinglake)  after  Sir  George 
Brown  (at  the  outset  hostile  to  Miss  Nightingale) 
saw  perfection  in  the  hospital  wards,  and  ascribed 
it  to  womanly  energies. 

Thus  sorrily  lagged  the  males  [he  concludes]  in 
their  undesigned  trial  of  speed  and  power  with  what 
proved  to  be  not  only  the  swifter,  not  only  the  more 
agile  mind,  but  also  the  higher  capacity  for  executive 
business,  and  even  the  more  intent  will.^ 

'  Kinglake,  op.  cit.,  vol.  vi.,  pp.  443-445. 


144  A  History  of  Nursing 

After  her  return  from  the  Crimea  Miss  Nightin- 
gale gave  testimony  before  a  royal  commission, 
in  which  she  outlined  a  working  plan  of  organisa- 
tion for  military  hospitals  and  briefly  pointed  out 
the  radical  defects  then  obtaining  as  follows :  ^ 

In  the  military  general  hospitals,  as  they  are  now 
constituted,  the  governing  power  is  wanting  which  by 
its  superior  authority  can  compel  the  co-ordinate 
departments  within  the  hospital  to  the  complete 
co-ordination  necessary  for  success.  [She  compares 
the  naval  hospitals,  where  there  is  one  head,  and 
continues :]  One  executive,  responsible  head,  it  seems 
to  me,  is  what  is  wanted  in  a  general  hospital,  call 
him  governor,  commandant,  or  what  you  will,  and  let 
it  be  his  sole  command. 

The  departments  should  not  be  many: 

1.  A  governor,  solely  responsible  for  everything 
except  medical  treatment. 

2.  A  principal  medical  officer,  and  his  staff,  relieved 
of  all  administrative  duties  and  strictly  professional. 

3.  A  steward  who  should  fulfil  the  duties  of  pur- 
veyor, commissary,  and  barrackmaster,  and  supply 
everything,  subject  to  the  governor. 

4.  A  treasurer,  who  should  be  banker  and  pay- 
master. 

5.  A  superintendent  of  hospital  attendants,  who 
should  undertake  the  direction  of  cooking,  washing, 

»  The  Sanitary  Condition  of  the  Army;  A  Report  of  the 
Commission  appointed  to  inquire  into  the  Regulations  affect- 
ing the  Sanitary  Conditions  of  the  Army,  the  organisation  of 
Military  Hospitals,  the  treatment  of  the  Sick  and  Wounded. 
Presented  to  both  houses  of  Parliament  by  command  of  her 
Majesty.     London,  1858.     Westminster  Review,  Jan.,  1859. 


Miss  Nightingale  and  Crimean  War  145 

care  of  hospital  furniture,  and  government  of  orderlies. 
All  of  these  officers  to  be  appointed  at  home  by  the 
War  Department.  According  to  this  plan  the  govern- 
ment would  culminate  the  functions  of  quarter- 
master-general and  adjutant-general  and,  under  the 
advice  of  a  sanitary  officer  attached  to  him  for  that 
purpose,  would  be  solely  responsible  for  carrying 
out  the  works  advised  and  for  engaging  the  requisite 
labour.  With  regard  to  the  mode  of  supply  let  the 
steward  furnish  the  hospital  according  to  a  fixed 
scale  previously  agreed  upon. 

With  regard  to  food  let  the  steward  make  contracts 
subject  to  the  governor's  approval,  and  with  power  to 
buy  in  the  markets  at  the  contractor's  expense  if 
the  contractor  fails.  A  scheme  of  diets  should  be 
constructed,  according  to  the  most  approved  authori- 
ties, in  order  to  save  the  cumbrous  machinery  of 
extra  diet  rolls.  Equivalents  might  be  laid  down,  so 
as  to  afford  the  necessary  choice,  dependent  on  the 
nature  of  the  climate,  the  season  of  the  year,  the 
state  of  the  market,  the  produce  of  the  country,  etc. 

This  schedule  shows  in  brief,  and  her  remarkable 
monograph  on  the  British  army  in  detail,  the 
lamentable  absence  of  all  intelligent  foresight 
which  made  the  Crimean  calamities  so  spectacular. 
Common-sense  was  stifled  in  routine  and  regula- 
tions; these,  in  turn,  were  fossilised  by  profes- 
sional jealousy,  timorousness,  and  selfishness. 
This  shines  out  clearly  from  all  the  testimony 
given  later  before  the  commission,  and  is  thrown 
into  even  stronger  relief  by  apologists,  while  the 
experiences  of  later  wars  have  reduplicated  all 

VOL.  II.  — 10 


14^  A  History  of  Nursing 

of   Miss   Nightingale's   accusations,    and   verified 
her  warnings. 

Her  letter  of  Jan.  8th,  to  Sidney  Herbert  ^ 
shows  a  masterly  grasp  of  the  whole  cause  and 
root  of  the  disorganisation,  and  is  of  peculiar 
interest  both  as  a  study  of  her  graphic,  vivid,  and 
concise  mode  of  expression  and  of  her  mental 
keenness.  It  is  indeed  a  "terrible  letter,"  for  the 
truth  was  terrible.  Its  sentences  are  like  flashes 
of  lightning.  Stanmore  from  his  library  com- 
plains that  it  is  exaggerated  and  mischievous, 
thus  provoking  the  inference  that  he  had  for- 
gotten to  refer  to  even  so  much  of  the  official  testi- 
mony as  Miss  Nightingale  quotes  in  the  Notes. 
One  of  its  opening  paragraphs  sets  forth  very 
strikingly  the  moral  cowardice  and  supineness  of 
the  men  in  charge: 

The  Commission  has  done  nothing.  .  .  .  Gum- 
ming has  done  nothing.  Lord  William  Paulet  has 
done  nothing.  Lord  Stratford,  absorbed  in  politics, 
does  not  know  the  circumstances.  Lord  William 
Paulet  knows  them  but  partially.  Menzies  knows 
them  and  will  not  tell  them.  Wreford  knows  them 
and  is  stupefied.  The  medical  officers,  if  they  were 
to  betray  them,  would  have  it  reported  personally 
and  professionally  to  their  (dis)  advantage.  .  .   . 

.  .  .  You  will  say  that  I  ought  to  have  reported 
these  things  before.  But  I  did  not  wish  to  be  made 
a  spy.  I  thought  it  better  if  the  remedy  could  be 
brought  quietly,  and  I  thought  the  Commission  was 

»  Memoirs  of  Sidney  Herbert,  vol.  i.,  pp.  393-396. 


Miss  Nightingale  and  Crimean  War  147 

to  bring  it.     But  matters  are  worse  than  they  were 
two  months  ago.     .     .     .  ^ 

After  the  war  was  over  and  Miss  Nightingale 
had  returned  to  England  the  question  of  how  to 
remedy  the  evils  of  which  she  had  become  cogni- 
sant absorbed  her  mind  and  energy  for  a  long 
time.  She  took  a  keen  interest  in  the  appoint- 
ment of  the  Royal  Commission  to  investigate  the 
Sanitary  State  of  the  Army,  of  which  Sidney 
Herbert  was  appointed  chairman,  and,  perceiving 
well  that  powerful  interests  would  endeavour  to 
delay  and  mutilate  the  Commissioners'  findings, 
she  urged  Sidney  Herbert  not  to  accept  the  chair- 
manship without  receiving  a  definite  pledge  that 
the  recommendations  of  the  Commission  should  be 
acted  upon.     She  wrote  to  him: 

All  that  Lord  Panmure  has  hitherto  done  (and  it 
is  just  six  months  since  I  came  home)  has  been  to 
gain  time,  and  this  Commission,  I  hold  it,  granting 
it  only  as  he  does  }ww,  is  also  merely  to  gain  time. 

He  has  broken  his  most  solemn  promises  to  Dr. 
Sutherland,  to  me,  and  to  the  Crimean  Commission, 
and  three  months  from  this  day  I  publish  my  ex- 
perience of  the  Crimean  campaign,  and  my  sugges- 
tions for  improvement,  unless  there  has  been  a  fair 
and  tangible  pledge  by  that  time  for  reform.  ^ 

In  this  connection  it  is  of  interest  to  note  Queen 
Victoria's  comment  on  Miss  Nightingale,  after  the 
war,  in  a  personal  letter  to  the  Duke  of  Cambridge : 

>  Memoirs,  vol.  i.,  p.  393, 
2  Ibid.,  vol.  ii.,  p.  123. 


148  A  History  of  Nursing 

We  have  made  Miss  Nightingale's  acquaintance 
[she  wrote]  and  are  deHghted  and  very  much  struck 
by  her  great  gentleness  and  simplicity,  and  wonder- 
ful, clear,  and  comprehensive  head.  I  wish  we  had 
her  at  the  War  Office. 

We  return  now  to  Scutari,  where  the  nursing 
service  experienced  one  of  the  haphazard  methods 
of  the  War  Office.  It  had  been  arranged  for  that 
reinforcements  of  nurses  should  be  sent  out  if 
needed,  but  only  on  Miss  Nightingale's  "auto- 
graph request."  ^  The  Lady  Volunteer  writes  of 
the  later  nursing  staff : 

Their  selection  was  left  in  the  hands  of  Mrs.  Sidney 
Herbert,  Miss  Stanley,  sister  of  Dean  Stanley,  and 
Miss  Jones,  Superintendent  of  St.  John's  House.  As 
a  test  of  qualifications  of  the  applicants,  it  was  agreed 
that,  with  few  exceptions,  all  should  go  through 
training  at  some  of  the  London  hospitals,  and  to 
facilitate  this,  St.  John's  House  and  St.  Saviour's 
home  were  opened  to  receive  probationers,  and 
latterly  a  third  institution  was  established  for  the 
same  purpose  under  the  patronage  of  the  Earl  of 
Shaftesbury.  ^ 

In  some  unexplained  way,  a  second  party  of 
forty-six  was  sent  out  in  charge  of  Miss  Stanley 
in  December,  1855,  not  only  without  Miss  Night- 
ingale's "autograph  request,"  but  even  without 
her  knowledge,  until  they  were  on  the  way.      But 

1  Her  own  words  in  Notes  on  the  British  Army,  p.  154, 
showing  Stanmore  to  be  inaccurate  in  his  account  of  this 
incident. 

2  Op.  cit.,  vol.  i.,  pp.  9-10. 


Miss  Nightingale  and  Crimean  War  149 

this  was  not  all.  Not  only  were  the  nurses  de- 
spatched without  inquiring  whether  they  could  be 
quartered  and  assigned  to  duty,  but,  to  complete 
the  blunder,  they  were  consigned  to  Dr.  Gum- 
ming (who,  as  many  indications  would  appear  to 
show,  was  by  no  means  friendly),  and  not  to  the 
Lady-in-Chief .  ^ 

It  is  unnecessary  to  point  out  the  unsystematic 
character  of  this  proceeding,  and,  remembering  the 
regular  correspondence  between  ]\Iiss  Nightingale 
and  Mr.  Herbert,  it  seems  quite  inexplicable, 
unless  it  was  that  the  problems  of  the  nursing 
department  were  lost  in  the  titanic  proportions 
of  the  general  mismanagement. 

No  one  at  this  distance  can  estimate  properly 
the  dangers  and  difhculties  surrounding  Miss 
Nightingale  and  her  nurses  in  this  at  that  time 
new  and  untried  position,  nor  may  it  be  won- 
dered at  that  this  action  disturbed  and  an- 
noyed her. 

As  Miss  Nightingale's  own  story  of  those  days 
has  never  been  told,  nor  her  letters  published,  the 
few  extracts  from  them  presented  with  carp- 
ing criticism  by  Sidney  Herbert's  biographer  in 
relation  to  this  incident  cannot  be  considered 
as  affording  definite  or  final  information,  nor, 
without  the  ability  to  show  her  side  of  the  story, 
does  it  even  seem  worth  while  to  discuss  them. 

Miss  Stanley  and  her  nurses  w^ere  halted  at 
Therapia,   puzzled   enough   at  the   delay.     They 

1  Memoirs  of  Sidney  Herbert,  vol.  i.,  p.  372. 


I50  A  History  of  Nursing 

were  told  to  take  up  their  abode  in  an  empty  house, 
which,  however,  Miss  Stanley  succeeded,  before 
nightfall,  in  furnishing.  It  had  been  her  intention 
to  return  immediately  to  England  after  landing 
the  nurses,  but  now,  seeing  that  difficulties  were 
before  them,  she  decided  to  remain  with  them. 
Three  days  afterward  she  went  to  Scutari  to 
see  ]\liss  Nightingale,  whom  she  writes  of  as 
"dear  Flo." 

I  went  through  a  door  [she  wrote  home],  and  there 
sat  dear  Flo  writing  on  a  small  unpainted  deal  table. 
I  never  saw  her  looking  better.  She  had  on  her 
black  merino,  trimmed  with  black  velvet,  clean  linen 
collar  and  cuffs,  apron,  white  cap  with  a  black  hand- 
kerchief tied  over  it.  ...  I  was  quite  satisfied  with 
my  welcome.   .   .  .  ^ 

Although  Miss  Stanley  then  learned  the  whole 
state  of  things,  it  has  not  been  made  known  to 
the  public.  Her  letter  shows  perplexity  and  con- 
cern. The  inference  is  clear  that,  in  order  to 
resist  the  undermining  of  her  legitimate  authority, 
and,  possibly,  to  expose  intrigue.  Miss  Nightingale 
was  fearless  enough  to  declare  her  determination 
to  resign  rather  than  remain  under  conditions 
which  would  fetter  her. 

The  crisis  passed.  Sidney  Herbert  would  not 
hear  of  resignation;  loyally  (and  properly)  took 
upon  himself  the  blame  of  the  unannounced  party 
of  nurses,  and  after  a  month's  delay  they  were 
distributed  among  the  various  hospitals. 

«  Memoirs,  vol.  i.,  p.  374. 


Miss  Nightingale  and  Crimean  War  151 

Miss  Stanley  remained  with  them  for  six 
months,  and,  though  of  deHcate  health  and  without 
any  experience  in  nursing,  gave  invaluable  service 
in  supervising  and  chaperoning  them,  and  in  over- 
coming prejudice  and  opposition. 

This  second  party  consisted  of  fifteen  Roman 
Catholic  nuns,  nine  lady  volunteers,  and  twenty- 
two  nurses.  Miss  Nightingale  has  left  the  fol- 
lowing allusion   to   the   nursing   staff. 

It  [the  party]  was  followed  by  numerous  additions 
during  the  year  1855,  and  the  female  nursing  estab- 
lishment was  only  broken  up  with  the  return  of  the 
army  in  July  1856,  the  Superintendent  leaving  finally 
on  July  28,  1856.  During  this  period  a  great  number 
had  returned  home  from  sickness  and  other  causes. 
Nine  died.  ^ 

That  the  responsibility  of  the  nursing  staff  was 
a  heavy  one  may  be  learned  from  the  Lady  Volun- 
teer, who  writes  on  this  point: 

There  was  one  great  trouble  which  we  began  to 
feel  at  this  time — ^namely,  the  conduct  of  the  hired 
nurses.  We  had  indeed  been  tried  by  this  from 
the  beginning,  and  several,  as  I  have  mentioned,  were 
sent  home  for  bad  conduct;  but  still  the  distress 
around  them  and  the  frequent  sickness  among  their 
own  numbers  kept  some  sort  of  check  among  them, 
and  after  some  had  been  dismissed  for  bad  conduct, 
and  others  from  sickness,  only  two  remained  when 
the  new  party  arrived  on  April  9th. 

The  hospital  costume  in  which  Miss  Stanley's 
»  Notes  on  the  British  Army,  p.  155. 


152  A  History  of  Nursing 

party  left  England  was  worn  alike  by  ladies  and 
nurses,  which  was  intended  to  mark  the  equality 
system,  but  soon  after  beginning  hospital  work  w^ 
found  it  impossible  to  continue  wearing  the  same 
dress  as  the  nurses,  and  therefore  discontinued  it.   .  .  . 

The  ladies  soon  found  it  necessary  for  their  own 
comfort  and  for  the  good  of  their  work  that  in  every 
possible  way  the  distinction  should  be  drawn.  None 
but  those  who  knew  it  can  imagine  the  wearing 
anxiety  and  the  bitter  humiliation  the  charge  of  the 
hired  nurses  brought  upon  us,  for  it  should  be  re- 
membered that  we  stood  as  a  small  body  of  English 
women  in  a  foreign  country,  and  that  we  were  so  far 
a  community  that  the  act  of  one  disgraced  all.  .  .  . 
On  April  the  21st,  a  second  party  of  three  ladies  and 
seven  nurses  joined  us.   .   .   . 

A  few  weeks  only  had  elapsed  since  the  departure 
of  the  two  women  I  have  mentioned,  when  disgraceful 
misconduct  caused  the  dismissal  of  a  third.  Ere  a 
passage  could  be  had  for  her  another  was  obliged  to 
go,  from  her  habits  of  intoxication,  and  she  had  been 
one  most  highly  recommended.   .   .   . 

Our  trials  were  not  ended.  A  similar  case  of  bad 
conduct  obliged  the  dismissal  of  one  whom  we  had 
looked  upon  as  one  of  our  best  nurses.  Another 
was  found  intoxicated  in  the  wards;  these  two  went; 
and  so  till,  out  of  twenty-one,  in  less  than  eight 
months  we  had  eleven  left.  To  our  profound  aston- 
ishment we  found  that  our  sending  home  so  many 
gave  great  umbrage  to  the  authorities.  .  .  .  They 
thought  fit  to  send  a  reproof,  demanding  more  par- 
ticulars of  the  cases.   .   .   . 

They  were  respectfully  reminded  that  our  super- 
intendent's duties  did  not  include  the  reformation  of 


^ 


**Sairey  Gamp" 

A  nursa  of  sixty  years  ago 

By  ~»i-mission  from  Wellcome's  Professional  Nurse's  Diary.    Borroughs,  Wellcoine  i 

Co.,  igo7-3 


Miss  Nightingale  and  Crimean  War  153 

women  of  loose  character  and  immoral  habits,  nor 
did  we  imagine  the  authorities  would  require  details 
which  were  often  too  terrible  to  dwell  on. 

Of  the  remaining  nine  two  were  very  unsatisfactory. 

Six  were  respectful  and  industrious,  and  under  a 
lady's  supervision  did  very  well,  but  not  a  single  one 
except  Mrs.  Woodward  could  be  trusted  alone. 

The  light  conduct  of  another  of  the  hired  nurses, 
even  at  this  time  of  distress,  obliged  her  dismissal. 

.  .  .  After  some  days  she  recovered,  was  sent  home, 
and  I  believe  is  now  a  nurse  in  a  London  hospital.^ 

What  with  the  inexperience  of  the  ladies  and 
the  unreliability  of  the  paid  nurses,  the  nursing 
was  chiefly  confided  to  the  hands  of  the  Sisters  of 
Mercy,  whose  rigorous  training  stood  them  in 
good  stead,  and  whose  talents  for  system  and 
management  were  of  primary  importance.  They 
were  indefatigably  seconded  by  the  lady  volun- 
teers, and  bore  the  brunt  of  difficulties  in  the 
General  hospital  of  Scutari,  and  in  that  at 
Koulalee,  whose  lady  superintendent,  after  Miss 
Stanley  left,  was  Miss  Emily  Hutton.  This 
hospital  came  to  be  considered  a  model.  The 
Lady  Volunteer  writes : 

The  Mother  had  four  Sisters,  two  ladies,  and  two 
nurses  to  assist  her.  She  had  long  experience  in 
hospital  work,  and  possessed  a  skill  and  judgment  in 
nursing  attained  by  few.  This  hospital  from  first 
to  last  was  admirably  managed.  When  the  means 
of  improvement  were  placed  in  her  hands,  they  were 

^Op.  cit.,  vol.  ii.,  pp.  13-20. 


154  A  Histor}^  of  Nursing 

judiciously  used,  and  the  hospital  so  improved  that 
it  became  the  admiration  of  all  who  visited  it,  and  the 
pride  of  the  ladies  and  nurses  who  worked  in  it;  we 
used  to  call  it  "the  model  hospital  of  the  East." 

^liss  Nightingale  has  left  eloquent  and  heartfelt 
tributes  to  the  Sisters,  for  many  of  whom  she 
entertained  affection  and  regard. 

The  army  orderlies,  as  every  nurse  may  imagine, 
were  at  first  a  most  trying  class,  but  they  appear 
to  have  developed  under  the  influence  of  the 
ladies,  better  than  the  paid  nurses.  Miss  Nightin- 
gale inspired  them,  as  she  did  the  soldiers,  with 
a  chivalrous  devotion,  and  there  were  no  bounds 
to  the  ser\'ices  they  would  do  for  her.  She  her- 
self said  of  them: 

And  here,  homely  and  sickening  as  is  the  subject 
[she  had  been  describing  the  revolting  duties  that 
she  had  been  compelled  to  require  them  to  perform, 
and,  indeed,  to  assist  them  in],  I  must  pay  my  tribute 
to  the  instinctive  delicacy,  the  ready  attention  of  or- 
derlies and  patients  during  all  that  dreadful  period: 
for  my  sake,  they  performed  offices  of  this  kind  which 
they  neither  would  for  the  sake  of  discipline,  nor  for 
that  of  the  importance  of  their  own  health.  .  .  . 
And  never  one  word  nor  one  look  which  a  gentle- 
man would  not  have  used;  and  while  paying  this 
humble  tribute  to  humble  courtesy,  the  tears  come 
into  my  eyes,  as  I  think  how,  amidst  scenes  of  horrible 
filth,  of  loathsome  disease  and  death,  there  arose 
above  it  all  the  innate  dignity,  gentleness  and  chivalry 
of  the  men  (for  never,  surely,  was  chivalry  so  strikingly 
exemplified)   shining  in  the  midst   of  what  must  be 


Miss  Nightingale  and  Crimean  War  1 55 

considered  as  the  lowest  sinks  of  human  misery,  and 
preventing,  instinctively,  the  use  of  one  expression 
which  could  distress  a  gentlewoman.^ 

In  the  other  hospitals  the  same  was  said.  The 
Lady  Volunteer  wrote : 

Without  their  [the  ladies']  superintendence,  they 
[the  orderlies]  were  an  idle,  useless  set  of  men,  callous 
to  the  suffering  of  those  around  them,  not  trying  to 
learn  their  business,  which  was  of  course  new  to  them^ 
and  regardless  of  carrying  out  the  doctor's  orders, 
when  they  could  do  so  without  getting  into  disgrace ; 
but  under  the  Sisters'  and  ladies'  hands  they  became 
an  excellent  set  of  nurses,  forming  that  class  of  men- 
nurses  of  course  essential  in  a  military  hospital. 

.  .  .  The  orderHes  at  Balaclava  had  been  a  trou- 
blesome set,  unaccustomed  to  habits  of  clean- 
liness and  order;  reforms  were  now  introduced  and 
carried  out ;  encouragement  from  the  Sisters  and  their 
gentle  manners  did  much  more  good  in  teaching  the 
orderlies  than  all  the  blame  they  had  previously  re- 
ceived. Just  at  this  time,  the  corps  of  civil  orderlies, 
reported  to  be  already  trained  to  undertake  nursing, 
arrived  from  England.  They  landed  at  Scutari  and 
were  soon  dispersed  among  the  other  hospitals. 
They  all  wore  a  uniform  dress  of  blue  smocks,  and 
were  pronounced  by  the  soldiers  to  be  "a  set  of 
butchers." 

Not  the  least  of  Miss  Nightingale's  brilliant 
achievements  in  the  Crimea  was  the  social  and  re- 
lief work  she  did  there,  which  Pincoffs  among 
earlier  biographers  has  given  in  more  detail  than 

»  From  Notes  on  the  British  Army,  pp.  93-94. 


156  A  History  of  Nursing 

others  but  to  which  we  can  only  make  the  briefest 
reference :  the  care  of  the  wives  who  had  followed 
their  husbands,  and  of  the  little  new-born  child- 
ren; the  establishment  of  reading-rooms,  amuse- 
ments and  lectures  for  the  men;  of  a  cafe  at 
Inkerman  to  draw  the  men  away  from  the  can- 
teen; of  the  enormous  personally  conducted 
correspondence  with  the  wives  and  families  at 
home,  and  of  the  extemporised  money  order  office 
in  her  rooms  at  Scutari,  where  she  took  in  the 
men's  pay  for  transmission  home,  sending  thus 
to  the  families  in  England  about  £1000  every 
month.  This  work  of  hers  was  later  taken  over 
by  the  government. 

In  May  Miss  Nightingale  made  a  tour  of  in- 
spection of  the  hospitals  of  Balaclava,  and  while 
there  suffered  an  acute  attack  of  Crimean  fever. 
She  was  nursed  through  it  by  Mrs.  Roberts  and 
returned  to  Scutari,  w^eak  but  undiscouraged, 
about  a  month  after  leaving  it.  The  many  in- 
tensely interesting  details  of  her  tours  among  the 
hospitals,  of  which  a  number  are  related  by  Soyer, 
her  later  return  there  and  her  life  in  the  little  hut, 
while  superintending  the  arrangements  of  the 
army  of  occupation,  as  w^ell  as  the  later  events  in 
the  hospitals  at  Scutari,  must  be  passed  over, 
and  the  reader  referred  to  the  pages  of  her 
biographies. 

We  shall  now^  quote  from  Miss  Nightingale's 
own  summary  of  the  work  of  the  nursing  staff: 

.  .  .  Quarters  and  rations  were  assigned  to  them 


'%SSa: 


■%. 


Miss  Nighlingale's  Carriage 

"  The  extraordinary  exertions  Miss  Nightingale  imposed  upon  herself  after 
receiving  this  carriage  would  have  been  perfectly  incredible,  if  not  witnessed  by 
many.  I  can  vouch  for  the  fact,  having  frequently  accompanied  her  to  the  hospi- 
tals as  vt-ell  as  to  the  monastery.  The  return  from  these  places  at  night  was  a  very 
dangerous  experiment,  as  the  road  led  across  a  very  uneven  country.  It  was  still 
more  perilous  when  snow  was  upon  the  ground.  I  have  seen  that  lady  stand  for 
hours  at  the  top  of  a  bleak  rocky  mountain  near  the  hospitals,  giving  her  instruc- 
tions, while  the  snow  was  falling  heavily.  All  one  could  say  to  her  on  the  subject 
was  so  kindly  received,  that  you  concluded  you  had  persuaded  her  to  take  more 
care  of  herself.  Yet  she  always  went  on  in  the  same  way,  having  probably  for- 
gotten good  advice  in  her  anxiety  for  the  comfort  of  the  sick. 

*'  I  often  warned  her  of  the  danger  she  incurred  in  returning  so  late  at  night, 
with  no  other  escort  than  the  driver.  She  answered  by  a  smile,  which  seemed  to 
say,  'You  may  be  right,  but  I  have  faith.'" — Soyf.r,  o/.  cit.  pp.  418,  410 


Miss  Nightingale  and  Crimean  War  157 

within   the   Barrack   hospital,    at    Scutari,  .  .  .  and 
Miss  Nightingale  was  furnished  with  Instructions. 

It  was  not  until  March,  1856,  that  Miss  Nightingale 
was  put  individually  into  General  Orders.  But  no 
General  Order  has  ever  existed  defining  the  duties 
of  the  nurses,  in  the  various  hospitals  to  which  they 
were  respectively  attached. 

This  will  indicate  how  ill-defined  the  position 
of  the  nurses  was,  and  how  easily  their  control 
and  discipline  might  have  been  usurped  by  the 
military  ofhcials  had  not  Miss  Nightingale  been 
strong  and  able  enough  to  insist  on  retaining  her 
power. 

In  the  civil  hospitals  of  Smyrna  and  Renkioi  the 
iiumber  was  fixed  before  leaving  home,  together  with 
that  of  those  serving  in  other  departments.  With 
regard  to  Miss  Nightingale's  first  party,  the  number 
admitted  into  the  Barrack  and  General  hospitals, 
Scutari,  was  fixed  by  arrangement  with  the  respective 
principal  medical  officer  of  those  hospitals. 

But,  nevertheless,  the  number  admitted  into  each 
division  depended  upon  the  medical  officer  of  that 
division,  who  sometimes  accepted  them,  sometimes 
refused  them,  sometimes  accepted  them  after  they 
had  been  refused ;  while  the  duties  they  were  permitted 
to  perform  varied  according  to  the  will  of  each  in- 
dividual medical  officer,  and  each  one  successively, 
and  according  to  the  amount  of  occupation  of  medical 
officers  and  orderlies,  and  according  to  the  estima- 
tion in  which  each  individual  nurse  was  held  by 
each  individual  medical  officer. 

With  regard  to  extra  diets,  medical  comforts,  and 


158  A  History  of  Nursing 

"free  gifts"  nothing  was  given  by  the  nurses,  except 
by  the  order  of  the  superintendent,  which  order  was 
consequent  upon  the  requisition  of  a  medical  officer 
and  that  only,  with  some  few  exceptions.     .     .     . 

The  principle  introduced  by  Dr.  Meyer  in  the  civil 
hospital  at  Smyrna — and  afterwards  carried  out  in 
that  of  Renkioi — was,  that  a  certain  number  of  ladies 
should  have  the  superintendence  of  a  certain  num- 
ber of  paid  nurses.  This  did  not  interfere  with  the 
action  of  the  male  orderlies,  except  by  reducing  their 
labour  and  their  number.  In  each  case  the  females 
were  distinctly  under  the  direction  of  the  medical 
officers  and  had  more  or  less  charge  of  the  extra 
diets.   .   .   . 

Immediately  upon  the  arrival  of  the  nurses  at 
Scutari  in  November,  extra  diets  were  prepared  by 
them  for  the  patients,  in  the  stoves  which  they  had 
brought  with  them.  ...  In  the  Crimea,  extra-diet 
kitchens  were  organised  in  the  General  hospital, 
in  February,  1855;  and  at  the  Castle  hospital,  Bala- 
clava, in  April  1855;  i.e.  as  soon  as  female  attendance 
was  incorporated  into  each  respectively.   .   .  . 

A  portion  of  the  materials  for  the  extra  diets  at 
the  Barrack  hospital,  Scutari,  and  also  in  the  Crimea, 
was  found  by  Miss  Nightingale's  fiinds;  on  some  oc- 
casions because  the  supplies  in  the  purveyor's  store 
had  run  short;  on  others,  because  they  were  of  bad 
quality;  on  others,  again,  because  the  purveyor  de- 
clined to  furnish  the  articles  of  food  (although  on 
the  diet  rolls  of  he  medical  officers) ,  which  Miss 
Nightingale  then  purchased  in  the  open  market. 

The  second  purveyor-in-chief,  in  Ma3^  1855,  placed 
the  whole  of  the  liren  and  small  stores  for  the  wards, 
arranged  under  divisions,  under  the  care  of  the  nurses 


Miss  Nightingale  and  Crimean  War  159 

as  far  as  regarded  the  Barrack  hospital,  Scutari.  In 
November,  1855,  they  assumed  the  same  charge,  on  a 
somewhat  different  footing,  in  the  General  hospital; 
but  in  the  Crimea  it  was  arranged  that  the  mass  of 
linen  should  be  sent  down  to  Scutari  to  be  washed. 
Where  women  form  part  of  a  hospital  establishment 
the  charge  of  the  linen  should  evidently  devolve  upon 
them. 

In  conclusion,  it  should  be  recorded  that  the  three 
periods  when  the  Female  Department  gave  the 
greatest  proofs  of  their  utility  were :  first,  on  the  arrival 
of  the  wounded  from  Inkerman,  at  Scutari,  Nov. 
9,  1854,  and  during  the  subsequent  months  when  the 
army  suffered  most  from  sickness  up  to  April  1855. 
After  that  time,  a  great  many  officials  of  every  de- 
partment were  added  to  the  hospitals  at  Scutari,  a 
great  decrease  of  sick  and  wounded  took  place  there, 
owing  to  the  improved  health  of  the  army  and  the 
development  of  hospitals  in  the  Crimea,  and  a  con- 
siderable accession  of  stores  had  arrived.  The  second 
period  of  their  usefulness  was  during  the  heavy  sum- 
mer work  of  nursing  the  wounded  in  the  Castle  hos- 
pital. Balaclava,  1855,  and  the  third,  when,  in  the 
spring  of  1856,  in  consequence  of  great  sickness 
among  the  Land  Transport  Corps,  there  was  a  press- 
ure upon  the  two  general  hospitals  for  that  corps 
organised  near  Karani  in  the  Crimea  by  the  excellent 
Principal  Medical  Officer,  Dr.  Taylor. 

Any  one  who  has  well  considered  the  subject  of 
nurses  and  hospitals  .  .  .  will  probably  come  to  the 
conclusion  that,  when  the  nursing  is  applied  not  to 
civil  but  to  military  hospitals,  the  mode  of  nursing 
by  orderlies,  who  perform  also  the  drudgery  of  hospital 
servants,  should  by  no  means  be  done  away  with. 


i6o  A  History  of  Nursing 

To  take  an\i:hing  from  the  authority  of  the  medical 
officers,  or  to  reduce  their  responsibility,  would  never 
be  contemplated  by  any  one  con  zinced  of  the  para- 
mount importance  of  the  promptitude  of  action 
resulting  from  unity  of  government.  It  remains, 
therefore,  that  female  nursing,  while  entirely  sub- 
ordinated to  the  medical  authority,  should  not  be 
charged  with  the  mere  drudgery  in ,  the  necessary 
cleansing  and  labour  of  a  military  hospital,  but 
should  be  made  capable  of  performing  what  may  be 
termed  "skilled"  nursing,  by  a  course  of  previous 
instruction,  and  should  add  to  the  niceties  of  female 
attendance,  which  have  been  found  so  grateful  to 
the  patient  in  all  civil  hospitals  and  in  domestic 
life,  a  moral  influence  which  has  now  been  proved, 
beyond  all  doubt,  to  be  highly  beneficial  to  the 
soldier. 

Although,  from  the  great  difficulties  presented  by 
the  diversity  of  character  of  those  who  went  out  first 
and  of  those  who  subsequently  followed  during  the 
whole  of  the  campaign,  a  stumbling  block  was  added 
to  the  many  difficulties  at  the  very  threshold  of  the 
undertaking,  yet  nevertheless  the  withdrawal  from 
the  work  of  those  w^ho,  from  time  to  time,  showed 
themselves  incompetent,  and  the  recognised  system 
of  discipline  introduced,  brought  the  corps  of  female 
nurses  into  such  a  condition  as  to  enable  them  to 
continue  the  work  throughout  the  campaign.  .  .   . 

Discipline,  founded  on  actual  efficiency  in  the 
service,  and  without  respect  of  persons,  was  imme- 
diately adopted,  and  this  necessaril}'  occasioned  the 
sending  home  of  those  who  proved  incompetent.   .   .  . 

A  primary  principle  of  discipline  was,  that  no  in- 
terference  with   the   regulation   of  the   hospital,  or 


^ 


4)      <2 

■5  k 


Miss  Nightingale  and  Crimean  War  i6i 


with  the   legitimate   orders   of  the  medical   officers, 
should  take  place.   .  .  . 

Upon  the  foregoing  principles  the  nurses  in  some 
cases  performed  larger  duties,  in  assisting  the  sur- 
geons, than  in  others,  according  to  the  orders  of  the 
particular  medical  officer.  The  system  of  requisition 
by  a  medical  officer  was  also  accepted  and  acted  upon 
by  Miss  Nightingale,  who  answered  the  requisition  of 
surgeons,  both  for  extra  diets,  medical  comforts,  and 
necessaries.  ^ 

After  peace  was  declared.  Miss  Nightingale 
saw  all  the  hospitals  of  the  Crimea  closed  one  by 
one;  stopped  at  Scutari  and  closed  the  Barrack 
hospital — with  what  emotions  one  may  imagine — 
and  returned  to  England,  reaching  home  in  August, 
1856. 

That  Miss  Nightingale  could  hold  such  a  po- 
siton  as  hers  in  the  Crimea  without  incurring 
enmity  is  naturally  not  to  be  expected.  As  a 
matter  of  history,  she  did  encounter  every  variety 
of  antagonism  which  might  be  expected  to-day 
in  such  work,  and  another  beside,  fortunately 
less  common  now  than  then  —  the  antagonism 
of  sectarian  intolerance.  In  reading  the  history 
of  social  movements  in  the  first  half  of  the  last 
century,  it  is  strikingly  evident  that  doctrinal 
jealousies  and  animosities  were  often  fatal  ob- 
stacles to  the  improvement  of  pitiful  or  even 
shocking  social  conditions;  and  it  was  with  only 

1  Notes  on  the  British  Army,  pp.  152-163.  (In  these  reports 
Miss  Nightingale  always  speaks  of  herself  in  the  third  person.) 


i62  A  History  of  Nursing 

too  much  reason  that  Sidney  Herbert  had  stated, 
in  a  pubHc  letter,  that  the  hospitals  should  not 
be  used  as  "the  arena  of  hostile  efforts  directed 
by  rival  creeds  one  against  the  other.  ^  Miss 
Nightingale  with  her  whole  family  belonged  to 
that  serener  circle  which  rose  above  narrow  sec- 
tarian prejudice.  Her  heart  went  out  equally  to 
Mrs.  Fry  the  Quaker,  Pastor  Fliedner  the  Lu- 
theran, and  the  Catholic  Sisters  of  Mercy,  but 
the  buzzing  of  intolerance  must  sometimes  have 
risen  to  her  ears.  Lady  Byron  once  wrote:  "I 
hope  you  have  traced  the  course  of  Florence 
Nightingale.  She  has  placed  women  in  the  right 
position,  as  head  of  the  humane  department.  .  .  . 
The  enmity  towards  her  appears  from  various 
testimonials  to  be  increased,  but  she  smiles  at  it 
all — an  angel  smile."  Dean  Stanley  in  a  letter 
said:  "In  this  nurse  business  there  is  no  question 
that  the  rabid  Protestant  party  have  shown  by 
far  the  greatest  incapacity  for  tolerating  anything 
beyond  their  own  infinitely  little  minds";  and  he 
then  related  how  his  sister  was  stopped  one  day 
in  the  hospital  by  the  chaplain,  who  complained 
of  having  found  a  copy  of  Keble's  Christian  Year 
in  the  wards.  The  next  Sunday,  in  the  presence 
of  Aliss  Stanley  and  her  nurses,  this  chaplain 
preached  against  herself  and  them  as  "creeping 
in  unaw^ares."  2  Mr.  Osborne  wrote  of  Miss  Night- 
ingale: "I  have  heard  and  read  with  indignation 

»  The  Times,  Oct.   24,    1854. 

■  "f-ih  and  Lettets  of  Dean  Stanley,  vol.  i.,  p.  492. 


Miss  Nightingale  and  Crimean  War  163 

the  remarks  hazarded  upon  her  religious  character. 
I  found  her  myself  to  be  in  every  word  and  action 
a  Christian;  I  thought  this  quite  enough.  It 
would  have  been  in  my  opinion  the  most  cruel 
impertinence  to  scrutinise  her  words  and  acts  to 
discover  to  which  of  the  many  bodies  of  true 
Christians  she  belonged."  The  Sisters  of  Mercy 
have  recorded  the  warning  letters  they  received 
from  the  War  Office,  inspired,  as  they  felt,  by  some 
of  the  Protestant  clergy,  and  reminding  them  that 
they  were  only  nurses,  and  that  St.  Paul  had  said 
women  were  not  to  teach  or  preach.  But  **  mil- 
lions of  tracts"  most  offensive  to  Catholics  were 
distributed  among  the  Catholic  soldiers,  and  the 
Sisters  found  them  in  every  supply  of  clothing 
sent  out  of  England.^ 

Sister  Mary  Aloysius,  who  possessed  a  great 
fund  of  humour,  described  vivaciously  the  merri- 
ment caused  in  the  nursing  staff  by  ponderously 
solemn  warnings  against  popery  in  the  English 
papers. 

As  a  result  of  one  tirade,  the  Sisters  named  Miss 
Nightingale  "Your  Holiness"  and  she  in  turn 
called  one  of  them  always  "the  Cardinal."  ^ 

Besides  religious  suspicion  it  seems  probable 
that  the  racial  enmity  of  Celt  for  English  inspired 
some  unfriendly  acts ;  such  was  perhaps  the  source 
of  certain  medical  antagonisms  and  of  the  petty 

«  A  Sister  of  Mercy's  Memories  of  the  Crimea,  Sister  Mary 
Aloysius,  Bums  &  Oates,  London,  1904,  p.  41. 
2  76^.,  p.  89. 


164  A  History  of  Nursing 

refusal  of  hospital  officials  at  Balaclava  to  allow 
Miss  Nightingale  to  put  up  a  tent  which  she  had 
made  to  shelter  the  convalescents  from  the  glar- 
ing sun;  and  the  same  motive  is  irresistibly  sug- 
gested by  the  otherwise  inexplicable  animosity  of 
a  volume  published  in  recent  years. ^ 

Trouble  with  some  too  zealous  Sisters  is  also 
hinted  at  in  Sidney  Herbert's  letters. ^  It  was  a 
period  when  religious  enthusiasts  of  all  beliefs 
were  keen  to  proselytise.  Whether  the  Sisters 
actually  broke  rules  in  this  respect  or  not,  their 
own  chronicles  show  that  the  interest  was  close 
to  their  hearts,  and  in  the  midst  of  hardships 
and  toil  they  found  time  to  prophesy  that  Lady 
Herbert  and  Miss  Stanley  w^ould  become  Catholics, 
as  they  did.^ 

How  far  military  and  medical  jealousy  went  no 
one  but  Miss  Nightingale  herself  can  tell.  King- 
lake  says  that  the  military  commander  Sir  George 
Brown  and  his  successor,  Lord  William  Paulet 
were  warm  in  her  praise  and  cordially  assented 
when  the  War  Minister  wrote:  "You  will  find 
her  most  valuable — her  counsels  are  admirable 
suggestions."  Lord  Raglan,  the  Commander-in- 
chief,  spoke  of  her  as  an  auxiliary  general, 
and  gave  her,  according  to  Kinglake,  frank 
and    cordial    support.      With    him   she   kept   up 

1  Leaves  front  the  Annals  of  a  Sister  of  Mercy.  By  a  Mem- 
ber of  the  Order.     New  York,  Catholic  Pub.  Society,  1885. 

2  Memoirs,  vol.  i.,  pp.  412,  417. 

*  Leaves  from  the  Annals,  etc.     Vol.  ii.,  pp.  157,  161,  163. 


Miss  Nightingale  and  Crimean  War  165 

a  constant  interchange  of  official  communica- 
tions and  he  visited  her  in  her  tent  when  she  had 
fever.  It  was  naturally  the  bureaucratic  under- 
lings, and  those  who  resented  her  authority,  who 
disliked  her  most — the  red-tape  men,  whose  dense 
mediocrity  was  too  rudely  shocked  by  her  electric 
intelligence.  The  hard-working  ward  surgeons, 
and  all  of  those  who  were  trying  to  do  their  duty, 
regarded  her  as  a  powerful  support.  Kinglake 
says  that  the  overworked  and  harassed  surgeons 
used  her  name  as  a  menace  w^hen  the  red-tape 
men  were  too  intolerable,  and  were  wont  to 
threaten  them  effectively  with  the  anger  of  the 
Lady-in-Chief. 

Pincoffs,  who  has  left  one  of  the  best  accounts 
of  her,  and  who,  as  a  civilian  physician,  had  small 
love  for  his  military  brothers,  tells  how  the  junior 
medical  officers  and  orderlies  of  one  division  had 
been  instructed  that  "the  less  they  had  to  do 
with  Miss  Nightingale  and  her  people  the  better 
it  would  be  for  them."  ^  (He  also  records  that 
a  splendid  dissecting  room  w^as  built,  liberally 
provided  with  numerous  and  excellent  instru- 
ments, microscopes,  chemical  apparatus,  etc.  by 
the  government,  at  her  suggestion.)  ^ 

It  w^as  the  red-tape  officials  who  complained 
that  she  used  to  hasten  to  get  her  stores  out  first 
"for  fear"  that  the  supplies  would  come  through 
the  regular  channels;  that  she  did  not  give  them 

1  Op.  cit.,  p.  80. 
^Ibid.,  p.  55. 


1 66  A  History  of  Nursing 

"time"  ("it  was  always  more  time  the  males 
wanted,'*'  says  Kinglake) ;  and  these  were  the 
men  whose  feelings  were  outraged  when  she  com- 
manded the  orderlies,  on  an  historic  occasion,  to 
break  in  the  door  of  the  storerooms  and  distribute 
supplies  for  which  the  patients  were  suffering. 
(Nolan  says  that  the  authorities  used  to  lock  up 
her  private  stores  to  make  it  seem  as  if  they  were 
not  needed.)  ^  Naturally,  too,  the  incompetent 
pur\^eyor,  Wreford,  who  was  unable  to  buy  any- 
thing in  Stamboul  where  there  were  ample  mar- 
kets, must  have  disliked  her  thoroughly.  ^ 

It  is  intimated  in  Sidney  Herbert's  letters  that 
she  must  have  had  serious  difficulties  with  two  of 
the  medical  officers.  One  of  these  was  Dr.  Hall, 
and  it  is  obvious  on  reading  the  Notes  on  the  British 
Army  that  the  difficulty  here  arose  from  the 
incompatibility  of  ineptitude  and  genius.  The 
calibre  of  Dr.  Hall  is  shown  in  the  official  cor- 
respondence summed  up  by  Miss  Nightingale  in 
her  Notes :  on  March  1 2  he  wrote  to  the  London 
office  a  series  of  optimistic  inaccuracies  about  the 
health  of  the  army,  and  said : 

A  system  of  detraction  has  been  commenced  against 
our  establishments  and  has  been  kept  up  by  interested 
parties,  under  the  garb  of  philanthropy. 

»  The  Illustrated  History  of  the  War  with  Russia,  E.  H.  Nolan 
Ph.D.,  LL.D.,  J.  S.  Virtue,  London,  1857,  p.  710. 

2  On  this,  h^-percriticism  could  scarcely  go  further  than 
Lord  Stanmore's  peevish  query  as  to  whether  she  told  this 
purveyor  where  he  could  buy.     Memoirs,  vol.  i.,  p.  381. 


Miss  Nightingale  and  Crimean  War  167 

Some  of  these  detractors,  he  adds,  have  become  so, 
"to  regain  lost  moral  reputation,  and  others  to 
make  their  mission  of  importance,  and  they  wish 
the  world  to  believe  that  all  the  ameliorations  in 
our  institutions  are  entirely  owing  cither  to  their 
own  exertions  or  those  of  a  few  nurses;  and  I  am 
sorry  to  say  some  of  our  own  department  have 
pandered  to  this  and  have  been  rewarded  for  it."  ^ 

Another  interesting  example  of  ingenious 
evasion  was  the  testimony  given  by  Dr.  Menzies 
before  the  House  of  Commons  committee  as  to  a 
raw  mutton  chop  having  been  given  to  a  patient. 
The  explanation  given  by  the  purv^eyor  (again 
Mr.  Wreford)  was  that  Miss  Nightingale  and  her 
nurses  took  up  so  much  room  and  time  in  the 
general  kitchen  that  the  cooks  could  not  do  their 
work.  The  testimony  of  the  cook  himself  after- 
wards proved  that  ''Miss  Nightingale  and  her 
nurses  never  set  foot  in  the  general  kitchen."  ^ 

Still  another  misrepresentation,  which  Miss 
Nightingale  records,  is  contained  in  remarks  in  a 
letter  from  Lord  Paulet  to  Lord  Panmure  in  April, 
1855,  in  which  he  refers  to  Miss  Nightingale's  *  *  exten- 
sive establishment ' '  as  making  great  extra  work,  and 
also  remarks  that  he  has"  continual  applications 
from  the  ladies  and  nurses  for  extra  expenses."  ^ 

She  follows  this  with  exact  figures  about  her 
sources   of   private   funds   and    their    use   which 

1  Notes  on  the  British  Army,  preface  to  sec.  i,  pp.  xxiv- 
XXV.     The  italics  are  ours. 

2  Ihid.,  p.  363. 

3  Ibid.,  preface  to  sec.  iii,  p.  xii. 


i68  A  History  of  Nursing 

prove  the   second   statement   to   have   been   en- 
tirely false,  and  of  the  former,  remarks : 

Miss  Nightingale's  "extensive  establishment,"  con- 
sisting of  40  women,  was  housed  in  the  Barrack  hos- 
pital in  the  same  space  which,  in  corresponding 
quarters,  was  occupied  by  three  medical  officers  and 
their  servants,  and  in  about  the  same  space  as  was 
occupied  by  the  Commandant.  This  was  done  in 
order  to  make  no  pressure  for  room  on  an  already 
overcrowded  hospital.  It  could  not  have  been  done 
with  justice  to  the  women's  health,  had  not  Miss 
Nightingale  later  taken  a  house  in  Scutari  at  private 
expense,  to  which  every  nurse  attacked  with  fever 
was  removed.^ 

But,  annoying  as  these  incidents  may  have  been 
at  the  time,  they  were  swept  away  in  the  flood  of 
the  devotion  of  the  army,  and  public  gratitude 
and  recognition,  which  rose  to  a  height  rarely 
know^n,  and  remained  deep  and  steadfast  w^ith  a 
loyalty  seldom  equalled.  After  the  labours  of 
the  Crimean  War  were  over  there  were  some  who 
felt  aggrieved,  or  perhaps  it  would  be  better  to 
say  wounded,  that  where  so  many  had  equally 
striven  and  borne  hardship  and  unspeakable 
difficulties,  equally  braving  death  and  equally 
risking  parting  from  home  and  friends,  the  w^hole 
passion  of  recognition,  gratitude,  and  praise  of 
the  English  nation  should  be  poured  at  the  feet 
of   one   nurse — Miss   Nightingale. 

Dr.  South  in  a  printed  pamphlet  regretted  the 

»  Notes  on  the  British  Army,  pref.,  sec.  iii,  xxxii.,  xxxii'. 


Miss  Nightingale  and  Crimean  War  169 

absence  of  any  public  recognition  of  the  services 
of  Mrs.  Roberts,  whom  he  considered  to  have  been 
more  experienced  and  skilled  in  surgical  nursing 
than  any  one  in  the  Crimea.  No  doubt  the  friends 
and  supporters  of  the  other  volunteer  gentle- 
women on  the  nursing  staff  may  also  have  felt 
that  they  too  should  have  been  more  publicly 
recognised;  especially  those  who  had  held  super- 
visory positions,  as  Miss  Emily  Hutton,  who  was 
the  lady  superintendent  of  the  Koulalee  hospital, 
or  Miss  Weare,  who  had  charge  of  still  another, 
or  Miss  Stanley,  who  showed  high  devotion  and  an 
exquisite  spirit.^  And  the  friends  of  the  Sisters 
of  Mercy,  whose  endurance  and  unfailing  cheer- 
fulness under  hardship  had  excited  the  admira- 
tion of  all  who  saw  them,  may  have  felt  the  same 
thing,  for  Cardinal  Wiseman,  in  a  public  sermon, 
had  said:  ^  *'It  must  have  been  a  source  of  pain 
to  Roman  Catholics  that  no  manifestation  of 
feeling  had  ever  been  witnessed  toward  them  [the 
Sisters]  while  charity  that  had  sprung  up  sud- 
denly in  the  world  had  been  honoured  by  royal 
praise  and  commemorated  by  lasting  monuments." 
But  the  actual  significance  of  the  unexampled 
homage  offered  to  Miss  Nightingale  was  not 
grasped  by  any  one  of  these  critics, — not  by  Dr. 
South,   and    not    by  Cardinal    Wiseman.      From 

»  See  her  article  Ten  Days  in  the  Crimea  :  A  Reminiscence. 
Macmillan's  Magazine,  Feb.,  1862. 

2  Quoted  in  letter  of  Emily  Hutton,  in  Memories  of  the 
Crimea,  by  Sister  Mary  Aloysius,  p.  77. 


170  A  History  of  Nursing 

their  standpoint  they  were  right;  but  the  truth, 
vaguely  apprehended  if  not  defined  by  the  Eng- 
Hsh  people  and  by  thousands  of  observers  in  other 
lands,  was  that  with  ]\Iiss  Nightingale's  entrance 
on  the  scene  there  had  risen  a  new  ideal  and  a  new 
estimate  of  nursing  and  its  possibilities.  Gone 
forever,  from  the  time  when  she  applied  her  intel- 
lect to  the  problems  of  the  Crimea,  was  the  con- 
ception of  nursing  as  a  charity,  exceedingly 
meritorious  and  deserving  of  the  heavenly  reward 
for  its  self-sacrificing  character.  The  self-sacri- 
fice remained,  but  under  her  sway  nursing  shone 
forth  as  a  part  of  the  invincible  and  glorious  ad- 
vance of  science;  sanitary  science,  the  science  of 
health,  first,  and  of  disease  only  secondarily. 
Not  pity  alone,  but  prevention  foremost;  not 
only  the  amelioration  but  the  reduction  of  suffer- 
ing, was  now  typified  in  the  personality  of  this 
woman  not  only  as  a  possibility,  but  a  positive 
policy  for  future  generations.  As  her  far-famed 
little  lamp  dissipated  the  gloom  of  the  long  corri- 
dors at  Scutari,  so  her  genius  banished  old  mists 
of  stupidity,  misconception,  and  long-settled 
customs  in  the  realms  of  thought. 

Sickness,  through  so  many  centuries  regarded 
as  divine  vengeance  for  "original  sin" — fear- 
inspiring  and  mysterious — what  does  she  say  of 
it? 

Sickness  or  disease  is  Nature's  way  of  getting  rid 
of  the  effects  of  conditions  which  have  interfered 
with  health.     It  is  Nature's  attempt  to  cure. 


Miss  Nightingale  and  Crimean  War  171 

And  of  nursing,  long  regarded  by  the  devout  as 
the  hardest  of  sacrifices,  and  by  the  laity  as  an 
occupation  inexpressibly  low  and  repugnant  ? 

Nursing  is  putting  us  in  the  best  possible  condition 
for  Nature  to  restore  or  to  preserve  health,  to  pre- 
vent or  to  cure  disease  or  injury,  ...  to  enable  Na- 
ture to  set  up  her  restorative  processes;  to  expel  the 
intruder  disturbing  her  rules  of  health  and  life.  .  .  . 
Partly,  perhaps  mainly,  upon  nursing  must  depend 
whether  Nature  succeeds  or  fails  in  her  attempt  to  cure 
by  sickness.  Nursing  is  therefore  to  help  the  patient 
to  live.  Nursing  is  an  art,  and  an  art  requiring  an  organ- 
ised practical  and  scientific  training.  For  nursing  is 
the  skilled  servant  of  medicine,  surgery,  and  hygiene.  ^ 

And  what  says  she  of  the  nurse's  attitude 
toward  life?  For  many  centuries  it  had  been  a 
favorite  dogma  of  churchmen  that  an  inclination 
to  such  work  defied  the  normal  human  interest  and 
sympathies  and  could  only  be  based  on  some  trans- 
cendental or  supernatural  motive.     But  hear  her: 

I  give  a  quarter  of  a  century's  European  experience 
when  I  say  that  the  happiest  people,  the  fondest  of 
their  occupation,  the  most  thankful  for  their  lives,  are, 
in  my  opinion,  those  engaged  in  sick-nursing.  It  is 
a  mere  abuse  of  words  to  represent  the  life,  as  is  done 
by  some,  as  a  sacrifice  and  a  martyrdom.  But  there 
have  been  martyrs  in  it.  The  founders  and  pioneers 
of  almost  everything  that  is  best  must  be  martyrs. 
But  these  are  the  last  ever  to  think  themselves  so.^ 

1  Article  on  Nursing  the  Sick  from  Quain's  Dictionary  of 
Medicine,  Edition  of  1894. 

2  Introd.  to  Life  of  Agnes  Jones,  pp.  xxx-xxxi. 


CHAPTER  IV 

THE  NIGHTINGALE  SCHOOL  FOR  NURSES  AT  ST. 
THOMAS'S  HOSPITAL 

THE  desire  of  the  British  people  to  offer  Miss 
Nightingale  a  testimonial  had  been  ex- 
pressed at  a  public  meeting  held  at  Willis's 
Rooms,  on  November  29,  1855.  She  must  long 
have  cherished  the  wish  to  found  a  training  school 
for  nurses;  for  her  friends  the  Sidney  Herberts, 
when  consulted  as  to  the  form  the  testimonial 
might  take,  were  able  from  their  intimate  know- 
ledge of  her  to  advise  that  the  one  thing  she  would 
be  willing  to  accept  w^ould  be  the  means  of  found- 
ing such  a  school.  The  Duke  of  Cambridge  presided 
at  the  meeting  and  the  distinguished  company- 
present  represented  the  progressive  and  freer 
minds  rather  than  those  of  any  strict  or  rigid 
tenets.  The  bishops  of  the  Church  were  mostly  ab- 
sent ;  but  Dean  Stanley  w^as  there ;  Gladstone  sent 
a  letter  of  apology;  Sir  James  Clark,  M.D.,  Mr. 
C.  Locock,  M.D.,  Mr.  H.  Bence  Jones,  M.D.,  and 
Mr.  W.  Bowman  of  the  Royal  College  of  Surgeons 
were  mentioned  in  the  list  of  those  present.  The 
Duke  of  Cambridge,  after  stating  the  object  of  the 

172 


The  Nightingale  School  for  Nurses    173 

meeting,  suggested  that  the  offering  of  the  people 
be  raised  with  a  view  of  estabhshing  a  system  of 
nurses  under  Miss  Nightingale's  immediate  con- 
trol, and  that  she  should  be  left  unfettered  to 
select  her  own  council.  The  Marquis  of  Lans- 
downe  in  seconding  said: 

One  of  the  most  useful  lessons  of  the  war  would  be 
the  permanent  improvement  in  the  duty  of  attending 
the  sick  and  wounded  soldiers,  as  the  part  taken  by 
the  ladies  of  the  country  in  organising  and  inspiring 
that  improvement  would  be  among  its  most  glorious 
reminiscences.  .  .  .  [He  moved]  that  the  noble 
exertions  of  Miss  Nightingale  and  her  associates  in 
the  hospitals  of  the  East  and  the  valuable  services 
rendered  by  them  to  the  sick  and  wounded  of  the 
British  forces  demand  the  grateful  recognition  of  the 
British  people. 

Sir  James  Pakington  proposed  a  resolution  that 
funds  be  raised  to  ''enable  her  to  establish  an 
institution  for  the  training,  sustenance,  and  pro- 
tection of  nurses  and  hospital  attendants." 

Sir  James  Clark,  for  the  medical  profession,  said 
that  he  had  had  the  pleasure  of  being  acquainted 
with  Miss  Nightingale  for  many  years.  Long 
before  the  war  was  thought  of  he  had  known  her 
to  watch  day  and  night  by  the  bedsides  of  the 
sick,  and  knowing  the  beauty  and  goodness  of  her 
character  it  was  with  no  common  feelings  of  ad- 
miration he  had  watched  her  career  in  the  East. 
He  did  not  doubt  the  noble  exertions  of  Miss 


174  A  History  of  Nursing 

Nightingale  would  prove  a  permanent  blessing  to 
the  whole  country. 

Mr.  Sidney  Herbert  spoke  earnestly  and  to  the 
point.  He  urged  leaving  her  free  to  direct  her 
school,  for  "in  her  we  have  a  woman  of  genius." 
He  told  of  having  visited  her  at  Kaiserswerth,  of 
w^hat  he  had  heard  from  the  Fliedners  of  her  great 
ability ;  he  had  no  hesitation  in  saying  that  during 
the  course  of  the  war  Miss  Nightingale  had  exhib- 
ited greater  powers  of  organisation,  a  greater  fa- 
miliarity with  details,  with  a  comprehensive  view 
of  the  general  bearings  of  the  subject,  than  had 
marked  the  conduct  of  any  one  connected  with 
the  hospitals  during  the  war.  He  told  some 
anecdotes  gathered  from  the  soldiers, — how  they 
kissed  her  shadow  as  it  fell  on  them: 

She  would  speak  to  one  and  another,  and  nod  and 
smile  to  as  many  more,  but  she  could  n't  do  it  to  all, 
you  know,  for  we  lay  there  by  the  hundreds,  but  we 
would  kiss  her  shadow  as  it  fell  and  lay  back  on  our 
pillows  content.  [And  how  one  said]  before  she  came 
there  was  such  cussin'  and  swearin',  but  after  that  it 
was  as  holy  as  a  church. 

And  the  meeting  ended  with  great  enthusiasm.  ^ 

In  January,  1856,  while  still  in  the  Crimea,  Miss 
Nightingale  had  replied  to  a  letter  embodying 
the  proposals  of  the  testimonial  committee : 

Exposed  as  I  am  to  be  misinterpreted  and  mis- 

1  The  Times,  Nov.  30,  1855. 

A  number  of  other  public  meetings,  equally  successful, 
were  held  in  different  parts  of  Great  Britain.  See  Report 
of  the  Committee  of  the  Nightingale  Fund.     London,  1856. 


The  Nightingale  School  for  Nurses    175 

understood  in  a  field  of  action  in  which  the  work  is 
new,  compHcated,  and  distant  from  many  who  sit  in 
judgment  on  it,  it  is  indeed  an  abiding  support  to 
have  such  sympathy  and  such  appreciation  brought 
home  to  me  in  the  midst  of  labours  and  difficulties 
all  but  overpowering.  I  must  add,  however,  that 
my  present  work  is  such  as  I  would  never  desert  for 
any  other,  as  long  as  I  see  room  to  believe  that  what 
I  may  do  here  is  unfinished.  May  I,  then,  beg  you  to 
express  to  the  committee  that  I  accept  their  proposal, 
provided  I  may  do  so  on  their  understanding  of  this 
great  uncertainty  as  to  when  it  will  be  possible  for 
me  to  carry  it  out.^ 

A  pleasing  detail,  which  nurses  as  a  nile  do  not 
know,  was  that  the  soldiers  themselves  contributed 
over  £4000  to  the  Nightingale  fund.  The 
military  secretary,  writing  from  headquarters  in 
1856,  said: 

.  .  .  The  subscription  has  been  the  result  of  vol- 
untary individual  offerings,  and  plainly  indicates 
the  universal  feeling  of  gratitude  which  exists  among 
the  troops  engaged  in  the  Crimea  for  the  care  bestowed 
upon,  the  relief  administered  to,  themselves  and  their 
comrades,  at  the  period  of  their  greatest  sufferings, 
by  the  skilful  arrangements,  the  unwearying,  con- 
stant, personal  attention  of  Miss  Nightingale  and  the 
other  ladies  associated  with  her.  .  .  .^ 

When,  after  Miss  Nightingale's  return  from  the 
Crimea,  it  was,  after  a  few  years  of  waiting,  made 
evident  that  her  health  would  not  permit  her  to 

»  Wintle,  op.  cit.,  p.  121. 
'  Ibid.,  p.  122. 


176  A  History  of  Nursing 

direct  in  person  the  promised  school  for  nurses^ 
the  responsibility  was  placed  in  the  hands  of  a 
committee,  and  St.  Thomas's  hospital  selected  as 
the  place  to  try  the  experiment.  Dr.  Blackwell 
refers  to  this  period  of  her  life  in  a  letter  written 
to  her  sister  in  1859. 

Have  just  returned  from  an  interview  with  Miss 
Nightingale  in  relation  to  a  school  for  nurses  which  she 
wishes  to  establish.  My  old  friend's  health  is  failing 
from  the  pressure  of  mental  labour.  I  can't  go  into 
the  details  of  her  last  five  years  now,  but  the  labour 
has  been  and  is  immense.  I  think  I  have  never  known 
a  woman  labour  as  she  has  done.  It  is  a  most  re- 
markable experience.  She  indeed  deserves  the  name 
of  a  worker.  Of  course  we  conversed  very  earnestly 
about  the  numerous  plans  in  which  she  wished  to 
interest  me.  She  thinks  her  own  health  will  never 
permit  her  to  carry  out  her  plan  herself  and  I  much 
fear  she  is  right  in  this  belief.^ 

The  new  school  was  not  established  without 
much  hostile  comment  and  criticism.     Flippant 
society  ladies,  like  Lady  Pam,  thought  the  Nightin- 
gale fund 
great  htmibug.   .  .  .  The  nurses  are  very  good  now, 

1  Pioneer  Work  in  Opening  tlie  Medical  Profession  to  Wo- 
men, Longmans,  Green  &  Co.,  pp.  217,  218.  As,  after  her 
return  from  the  Crimea,  ^liss  Nightingale  had  fought  al- 
most single-handed,  except  for  Sidney  Herbert's  help,  the 
battle  to  overturn  the  antiquated  but  strongly  intrenched 
machinery  which  had  nearly  destroyed  the  British  army, 
those  who  know  the  cost  at  which  such  work  is  done  may 
readily  conjecture  that  Dr.  Blackwell's  remark  may  have 
referred  to  this  as  the  drain  on  Miss  Nightingale's  health. 


The  Nightingale  School  for  Nurses    177 

though  perhaps  they  do  drink  a  httle,  but  so  do  the 
ladies'  monthly  nurses,  and  nothing  can  be  better 
than  them;  poor  people,  it  must  be  so  tiresome  sitting 
up  all  night,  and  if  they  do  drink  a  little  too  much 
they  are  turned  away  and  others  got ! 

Strange  as  it  may  seem,  the  majority  of  the 
medical  men  of  the  day  appear  to  have  been,  if 
not  distinctly  unfriendly,  at  least  far  from  cordial 
supporters  of  the  proposed  plan,  and  those  who 
had  been  directly  concerned  with  the  management 
of  the  nurses  under  the  old  system  regarded  the 
new  one  as  a  sort  of  an  affront.  Such,  at  least, 
was  the  assertion  of  Dr.  South,  who  wrote  a 
pamphlet  adverse  to  the  projected  Nightingale 
school.  Dr.  South  was  senior  surgeon  at  St. 
Thomas's  hospital.  He  was  probably  quite  of 
the  old  school,  liked  to  have  his  nurses  on  the 
plane  of  domestic  servants,  was  patronising  and 
kindly  disposed  to  those  who  served  him,  and  not 
too  exacting  in  his  own  requirements.  He  was 
very  loyal  to  Mrs.  Roberts,  who  had  been  Sister 
in  his  wards  for  over  twenty  years,  and  felt  some 
chagrin  that  she  had  not  received  more  popular 
applause  for  her  share  of  the  toils  and  reforms  of 
the  Crimea.  His  arguments  are  worth  reviewing, 
because  they  show  so  plainly  what  a  different  idea 
was  present  at  that  time  in  the  average  medical 
mind  of  what  nursing  really  might  mean,  and 
how  little  he  actually  understood  of  w^hat  Miss 
Nightingale  wanted  to  do.  He  defended  the 
old-fashioned    nursing   system    as    excellent    and 

VOL.  II. — 12 


178  A  History  of  Nursing 

satisfactory;  warmly  defended  the  character  and 
conduct  of  the  Sisters  ^  (barely  mentioning,  how- 
ever, the  servant-nurses,  w^ith  whom  he  probably 
did  not  come  in  contact) ;  and  gave  an  account  of 
the  work  of  the  nurses  and  Sisters  and  the  way 
they  were  trained. 

The  training  of  the  Sisters  and  the  general 
control  of  the  nursing  work  had  been  entirely  in 
the  hands  of  the  medical  staff.  This  is  an  import- 
ant point  to  notice,  and  it  was,  no  doubt,  reason 
enough  for  the  resentment  felt  by  medical  men 
at  the  proposed  change.  The  Sisters  were  not 
taught  by  the  matron,  but  by  the  surgeons  and 
physicians.  They  were,  however,  taken  first 
into  the  matron's  office,  and  by  errands  and  by 
substituting  in  the  wards  they  gradually  learned 
the  hospital  ways.  They  were  then  put  on  pro- 
bation in  the  wards  and  were  trained  into  their 
duties  by  the  physicians.  The  terms  *' nurse" 
and  "wardmaid"  were  synonymous,  and  either 
nurse  or  Sister  might  be  called  upon  to  re- 
main on  duty  all  night  after  a  day  of  fourteen 
hours,  during  which  time,  the  writer  adds  in- 
cidentally, they  "rarely  sat  down  for  five  min- 

'The  superior  rank  of  the  Sister  had  been  emphasised  in 
1699,  by  an  ordinance  that  only  the  wives  of  freemen  should 
be  appointed  Sisters.  In  the  year  1752  the  degradation  of 
hospital  work  is  indicated  by  an  attempt  of  the  governors  to 
change  the  name  "  Sister"  to  "  Nurse,"  and  that  of  nurse  to 
"  helper,"  but  custom  was  too  strong  and  the  use  of  the 
familiar  terms  continued.  An  Historical  Account  of  St. 
Thomas's  Hospital.     Benj.  Golding,  London,  1819,  p.  207. 


The  Nightingale  School  for  Nurses  179 

utes."  He  then  considered  the  proposed  meeting 
at  Willis's  Rooms  to  promote  Miss  Nightingale's 
plan  for  teaching  nurses,  and  declared  that  the 
proposed  school  was  quite  unnecessary  and  super- 
fluous; that  statements  made  as  to  the  nursing 
inefficiency  and  bad  conditions  in  hospitals  were 
offensive  and  untrue;  that  Sidney  Herbert's 
words,  "It  was  hoped  that  through  Miss  Nightin- 
gale's proposition  nursing  would  be  raised  to  a 
pitch  of  efficiency  never  known  before,"  were  not 
founded  on  fact — that  hospital  nursing  was  not 
only  efficient  but  was  satisfactory  to  all  the  phy- 
sicians and  surgeons. 

That  this  proposed  hospital-nurse  training-school 
scheme  has  not  met  with  the  approbation  or  support 
of  the  medical  profession  is  beyond  all  doubt  [he  { 
wrote].  Among  the  signers  of  subscriptions  to  the 
Nightingale  Fund,  out  of  ninety-four  physicians  and 
seventy-nine  surgeons  from  the  seventeen  hospitals 
of  London,  only  three  physicians  and  one  surgeon  from 
one  hospital,  and  one  physician  from  a  second,  are 
found  among  the  supporters  of  the  scheme. 

(But  the  patients  were  not  asked  what  they 
thought  of  it.)  This,  to  his  mind,  is  proof  that 
the  existing  nursing  in  hospitals  was  as  near  as 
possible  to  being  what  it  should  be,  and  sufficient 
cause  for  a  natural  resentment  over  attacks  made 
by  persons  who  had  no  knowledge  of  the  subject. 
He  proves,  further,  that  there  was  no  need  of  more 
women  for  private  duty,  since  St.  John's  House 
and  the  Institute  for  Training  Nurses  (Mrs.  Fry's) 


i8o  A  History  of  Nursing 

were  filling  the  whole  field  and  doing  all  that  was 
required.  He  then  quoted  the  following  critic- 
ism on  English  hospitals,  which  is  taken  from 
the  pamphlet  on  Kaiserswerth  written  by  Miss 
Nightingale,  though  he  did  not  appear  to  know 
the  authorship : 

We  see  [it  ran],  as  every  one  conversant  with 
hospitals  knows,  a  school,  it  may  almost  be  said,  for 
immorality  and  impropriety — inevitable  where  women 
of  bad  character  are  admitted  as  nurses,  to  become 
worse  by  their  contact  with  the  male  patients  and 
young  surgeons ;  inevitable  where  the  nurses  have  to 
perform  every  office  in  the  male  wards,  which  it  is 
undesirable  to  exact  from  women  of  good  character 
— how  much  more,  from  those  of  bad? — inevitable 
where  the  examination  of  females  must  take  place 
before  a  school  of  medical  students.  We  see  the 
nurses  drinking,  we  see  the  neglect  at  night  o-wing  to 
their  falling  asleep. 

This  pamphlet  was  printed  without  Miss  Night- 
ingale's name,  and  Dr.  South's  unconsciousness  of 
its  source  is  rather  amusing  when  he  says  that 
he  does  not  pretend  to  know  where  *'he  or  she" 
got  this  information;  that  it  is  entirely  untrue 
as  regards  the  nurses  and  a  gross  libel  on  the 
young  surgeons;  adding  that  he  "fears  the 
writer  has  fallen  into  ver}^  bad  medical  company" ! 
How  different  was  his  standard  of  nursing  from 
Miss  Nightingale's  can  be  estimated  by  com- 
paring her  luminous  definition  "Nursing  is 
helping  the  patient  to  live"    with    his    amiable 


The  Nightingale  School  for  Nurses    i8i 

offhand     definition    of    the    duties  of    the  ward 
nurses : 

As  regards  the  nurses  or  wardmaids,  these  are  in 
much  the  same  position  as  housemaids  and  require 
Httle  teaching  beyond  that  of  poultice-making,  which 
is  easily  acquired,  the  enforcement  of  cleanliness,  and 
attention  to  the  patients'  wants. 

The  nurses  need  not,  he  thinks,  be  of  the  same 
class  required  for  Sisters,  nor  have  the  same  re- 
sponsibilities, nor  do  they  often  stay  more  than 
one  year  or  two  in  the  wards.  But  what  became 
of  them  then,  or  if  they  went  out  to  private  duty, 
he  does  not  ask.^ 

In  spite  of  individual  doubts  and  disapproval, 
and  with  the  encouragement  of  the  more  en- 
lightened members  of  society,  ^  the  Nightingale 
school  was  opened  with  fifteen  probationers  on 
June  15,  i860,  a  date  for  many  reasons,  and  from 
varied  standpoints,  the  most  memorable  in  the 
history  of  nursing.  For  now  was  established  a 
set   of    principles   distinctly  new  or   of   new  ap- 

>  Facts  Relating  to  Hospital  Nurses,  J.  F.  South.  London, 

1857. 

2  Mrs.  Jameson,  who  was  somewhat  in  advance  of  the 
ideas  of  her  own  day,  wrote  thus:  "It  is  an  undertaking 
wholly  new  to  our  English  customs,  much  at  variance  with 
the  usual  education  given  to  women  in  this  country.  If  it 
succeeds,  it  will  be  the  true,  the  lasting  glory  of  Florence 
Nightingale,  and  her  band  of  devoted  assistants,  that  they 
have  broken  down  a  'Chinese  wall'  of  prejudices,  religious, 
social,  professional,  and  have  established  a  precedent  which 
will  indeed  multiply  the  good  to  all  time."  Wintle,  op.  cii., 
p.  58. 


1 82  A  History  of  Nursing 

plication  to  nursing  orders.  Most  significant  and 
radical  was  the  recognition  of  science  as  the  su- 
preme authority  in  the  education  of  the  nurse. 
No  other  conflicting  authority  was  henceforth  to 
separate  her  path  from  that  of  advancing  medical 
knowledge.  With  this,  as  an  inevitable  corollary, 
was  the  complete  secularisation  of  her  calling; 
this,  combined  with  a  respectable,  or  it  might  be 
even  distinguished,  social  position,  set  her  free 
for  enlarged  possibilifes  of  usefulness.  No  less 
far-reaching  was  the  tacit  rejection  of  the  ancient 
corner-stone  of  poverty,  so  long  held  essential  for 
the  nurse,  which  had,  more  than  anything  else, 
kept  her  bound,  uneducated,  and  passive.  How- 
ever partially  and  experimentally,  the  new  system 
started  on  the  direction  following  which  she  w^as 
enabled  rapidly  to  gain  the  basis  on  which  all 
other  progress  rests,  that  of  economic  independ- 
ence. Nursing  now  ceased  to  be  a  penance,  a 
self-sacrifice,  or  a  merit  ensuring  a  high  place 
in  the  next  world,  and  was  firmly  established  as 
an  honourable,  if  laborious,  means  of  earning  one's 
livelihood. 

The  magnificent  plan  of  the  Nightingale  school 
was  that  it  should  above  all  else  prepare  women 
to  go  into  the  hospitals  and  infirmaries  and  there 
carry  on  further  the  work  of  nursing  reformation 
and  teaching,  and  this  plan  has  been  triumphantly 
carried  out.  The  Nightingale  probationers,  as 
they  were  called,  were  not  trained  to  be  private 
duty  nurses,  as  those  of  the  earliest  English  or- 


The  Nightingale  School  for  Nurses   183 

ganisations  had  been,  but  were  preeminently 
encouraged  to  become  pioneers,  teachers,  and 
regenerators  in  hospital  management  and  nursing 
systems,  and  St.  Thomas's  has  never  had  a  private 
nursing  department. 

As  vacancies  occurred  in  the  regular  staff  of  the 
hospital  they  were  filled  by  Nightingale  nurses, 
so  that,  eventually,  the  old  style  of  ward  nurse 
was  replaced  by  the  new.  It  w^ould  probably  be 
impossible  to  record  all  the  hospitals  that  were 
regenerated  by  the  Nightingale  nurses;  the  com- 
mittee preferred,  when  possible,  to  send  a  group 
under  one  recognised  head  to  initiate  reform  in 
other  institutions.  This  was  done  in  the  case  of 
the  Royal  Infirmary  and  the  great  Workhouse 
Infirmary  at  Liverpool,  the  Royal  Infirmary  at 
Edinburgh,  and  a  number  of  other  less  well 
known  but  not  less  important  infirmaries.  Im- 
portant hospitals  in  Ireland,  such  as  Sir  Patrick 
Dun's,  colonial  hospitals,  such  as  the  infirmary 
in  Sydney  and  the  General  hospital  at  Mon- 
treal, obtained  their  first  trained  heads  from  St. 
Thomas's,  as  did  also  St.  Bartholomew's;  and 
the  Empress  Victoria  of  Germany,  then  Crown 
Princess  of  Prussia,  sent  Fraulein  Fuhrmann,  who 
afterwards  developed  the  Victoria  House  or  train- 
ing school  for  nurses  in  Berlin,  to  St.  Thomas's  for 
her  preliminary  experience.  The  War  Office  recog- 
nised Miss  Nightingale's  work  by  selecting  a  su- 
perintendent of  nurses  for  the  Royal  Hospital  at 
Netley  in  1869,  with  a  staff  of  nurses  to  work  under 


1 84  A  History  of  Nursing 

her.  ^liss  Alice  Fisher,  who  regenerated  Blockley 
hospital,  was  a  Nightingale  nurse,  and  Miss  Linda 
Richards,  the  pioneer  nurse  of  the  United  States, 
enjoyed  the  advantages  of  post-graduate  work  in 
St.  Thomas's  and  of  Miss  Nightingale's  personal, 
kindly  interest  and  encouragement. 

Though  later  on  newer  schools,  beginning 
more  easily  where  this  had  to  break  the  ground, 
first  equalled  it  and  then,  for  a  time,  out-dis- 
tanced it,  none  can  ever  forget  its  debt  to  this, 
the  mother  school,  the  first  one  at  once  secular, 
non-sectarian,  soundly  organised,  adequate  in  its 
hospital  facilities,  and  based  on  teaching.  The 
head  nurses  were  paid  by  the  Nightingale  fund 
for  teaching  the  probationers,  the  matron  was 
paid  for  superintending  them,  and  the  medical 
instructor  for  his  ser\'ices  in  lecturing  to  them. 
Having  been  at  the  outset  a  most  radical  and  dar- 
ing innovation,  the  Nightingale  school  thereafter 
went  steadily  on  its  way,  becoming,  in  time,  con- 
sen'ative  through  so  doing,  while  the  forces  it  had 
released  to  action  turned  to  successive  innovations 
and  advanced  to  fresh  revolutions,  with  which  it 
was  not  always  in  sympathy. 

The  weak  point  (as  it  seems  now  to  us,  though 
it  must  be  noted  that  this  is  not  universally  agreed 
to  among  superintendents,  especially  in  England, 
where  a  superior  type  of  woman  is  found  in  do- 
mestic service)  in  the  composition  of  the  early 
English  schools  was  their  inheritance  and  contin- 
uation  in   modified   form   of   the    ser\^ant-nurse. 


A    ward  in   St.    Thomas's   Hospital,   after  the   establishment  of  the 
training  school.     One  of  the  old-time  nurses  in  the  foreground 


The  Nightingale  School  for  Nurses    185 

though  it  would  have  been  hard  not  to  accept  and 
continue  to  some  extent  a  class  distinction  which 
was  ingrained  in  the  social  order  and  had  so  long 
characterised  the  hospital  service  under  both 
lay  and  religious  governing  bodies.  Kaiserswerth 
had  ignored  all  class  distinctions,  and  so  had  Mrs. 
Fry's  Institute,  but  caste  had  reappeared  in  the  later 
German  organisations,  and  in  the  nursing  orders 
of  the  Anglican  Church.  It  would  perhaps  have 
been  impossible  then,  at  one  step,  to  secure  only 
probationers  who  were  of  the  class  of  gentlewomen 
in  sufficient  numbers  to  carry  on  all  the  work  of 
the  hospitals.  It  seems  to  have  been  tacitly  un- 
derstood in  those  early  days  that  private  duty 
nurses,  at  least,  must  be  recruited  largely  from 
among  those  of  a  lower  social  grade.  This  was 
not  regarded  with  disfavour,  but  rather  the  con- 
trary, and  some  English  matrons  still  hold  it  ad- 
visable. Miss  Nightingale's  writings  in  several 
places  indicate  this  general  view,  and  she  has  left 
comparisons  between  the  relative  advantages  of 
domestic  service  and  nursing,  showing  that  the 
same  women  might  choose  to  go  into  either  one 
or  the  other.  Though  in  the  school  the  lower 
social  class  was  not  prevented  from  rising  to  the 
superior  posts,  if  fitness  was  demonstrated,  yet 
the  social  difference  was  not  lost  sight  of,  and  the 
terms  "lady  nurse,"  ''lady  probationer,"  and  "ser- 
vant class"  are  found  on  every  page  of  English 
nursing  history  even  late  into  the  present  time. 
As  a  result,  the  nurses  of  Great  Britain  have  con- 


1 86  A  History  of  Nursing 

stituted  a  vertical  instead  of  a  transverse  section 
of  society.  This  has  been  from  one  standpoint  an 
advantage,  for  there  have  always  been  women  of 
the  highest  education  and  social  class  at  the  top, 
to  take  hospital  positions,  district  nursing  work, 
army  nursing  work,  and  to  direct  and  organise ;  with 
a  plain,  mediocre  body  beneath  them  to  do  the 
routine  hard  work.  But  it  has  been  a  disadvantage 
from  another  point  of  view,  for  it  has  definitely 
hindered  intelligent  and  loyal  organisation  among 
the  nurses  themselves  (this,  in  effect,  has  only 
developed  in  recent  years  and  since  a  rising  en- 
trance standard  has  tended  to  exclude  an  unedu- 
cated class)  and  so  has  clogged  the  feet  of  the  more 
public-spirited  members  of  the  nursing  profession, 
who,  early  discerning  the  higher  views  of  intelli- 
gent citizenship  as  obligations  of  a  trained  body 
of  workers,  have  not  ceased  to  aspire  to  a  higher 
educational  and  industrial  plane. 

The  greater  natural  dependence  of  this  class  may 
have  been  one  reason  why  the  earliest  English 
schools  after  St.  Thomas's  established  their  own 
private  duty  homes,  where  their  nurses,  after 
completion  of  their  hospital  serA'ice,  were  expected 
and  encouraged  to  remain  as  were  the  deaconesses 
in  their  motherhouses,  or  the  nurses  of  the  Conti- 
nental Red  Cross  societies  in  their  associations, 
actually  a  part  ©f  the  outfit  of  the  institution,  to 
be  rented  out  as  one  rents  utilities.  Precarious, 
then,  were  their  opportunities  of  receiving  calls 
or  hospital  positions  if  they  established  themselves 


The  Nightingale  School  for  Nurses    187 

independently,  for  such  a  thing  as  the  "co-opera- 
tive" or  alumnae  registry  was  then  unknown. 
While  they  remained  in  the  service  of  the  hospital 
they  received  a  salary,  while  their  earnings  went 
to  the  institution.  This  system,  an  inheritance 
bequeathed  by  the  old  monastic  systems,  had  the 
advantages  of  the  monastery — i,e.,  security  of 
home  and  support,  and  release  from  the  necessity 
of  seeking  employment.  These  were  strong  points, 
for,  though  work  is  dignified  and  worthy,  it  is  often 
hard  and  humiliating  to  look  for  work.  But  the 
dignity  and  corporate  wealth  of  the  monastery, 
with  its  ample  provision  for  old  age,  were  gone, 
and  in  the  average  secular  institution  this  system 
too  often  brought  in  its  train  a  dependent  old  age, 
insufficiently  provided  for  by  hospital  pensions 
and  charity.  Had  it  become  an  enduring  system 
the  condition  of  nurses  would  eventually  have  been 
little  better  in  England  than  on  the  Continent. 
But,  it  may  again  be  emphasised,  in  the  '6o's  and 
'70's  it  would  hardly  have  been  possible  to  go 
further  and  emancipate  the  nurses  completely  from 
the  old  form,  and  had  they  been  turned  loose  into 
the  world,  as  is  the  modern  nurse,  training  schools 
would  probably  have  lost  the  confidence  of  the 
public.  We  know  from  Miss  Nightingale's  writ- 
ings that  she  approved  keeping  the  certificated 
nurse  under  the  guardianship  of  her  school,  chiefly 
on  the  ground  that  she  might  always  have  a  home 
where  she  would  be  under  good  influence  and  be 
secured  from  the  disintegrating  effects  of  a  nomad 


i88  A  History  of  Nursing 

existence.  For  ]\Iiss  Nightingale  herself,  it  is 
without  question  that  only  the  purest  and  highest 
moral  and  ethical  standards  underlay  her  strong 
conviction  of  the  necessity  for  the  nurse's  thus  liv- 
ing in  a  home  under  close  permanent  tutelage  of 
her  school,  but  we  may  think  that  she  has  over- 
idealised  the  benefits  of  private  nursing  institu- 
tions under  autocratic  control  and  imderestimated 
the  value  of  free  association  on  a  self-governing 
basis. 

To  the  extent  to  which  the  Nightingale  school 
retained  the  older  and  more  military  ideas  in  this 
respect,  it  has  been  out  of  sympathy  with  the  later 
development  of  complete  organic  separation  of  the 
graduate  from  her  school,  and  her  evolution  into 
organised  self-governing  associations. 

The  reason  for  the  selection  of  St.  Thomas's  as  a 
training  field,  was  to  be  found  in  the  character  and 
personality  of  a  very  notable  woman  and  self- 
trained  nurse,  little  known  even  to  many  of  her 
contemporaries,  and  whose  name  to-day  would 
convey  no  meaning  whatever  to  the  great  army 
of  modern  young  nurses — so  little  has  the  im- 
portant work  which  she  did  for  nursing  been 
remembered, — ]\Irs.  Wardroper,  the  matron  of  the 
hospital.  In  the  early  50 's,  Mrs.  Wardroper,  a 
woman  of  refinement,  having  been  left  responsible 
for  the  care  of  a  little  family,  applied  for  the  post 
of  Sister  or  head  of  a  ward  in  St.  Thomas's  hos- 
pital, and,  through  the  interest  of  some  of  the 
authorities    who   knew    her,    received    the    post, 


The  Nightingale  School  for  Nurses    189 

though  she  knew  nothing  whatever  of  hospital  life. 
The  conditions  already  often  referred  to  were  the 
rule  in  the  hospital,  for  the  days  of  Sairey  Gamp 
were  in  full  swing ;  but  in  a  remarkably  short  time 
Mrs.  Wardroper  instituted  a  surprising  degree  of 
order  and  cleanliness,  as  well  as  sobriety.  The 
committee,  seeing  and  appreciating  the  improve- 
ments she  made,  gradually  gave  her  more  power, 
until  finally  she  had  all  the  wards  under  her  super- 
vision, and  was  given  the  post  of  matron.  Al- 
though regular  training  was  not  then  thought  of, 
yet  her  selection  of  candidates  for  the  positions  of 
nurses,  her  discipline  and  influence,  system  and  in- 
telligence in  the  care  of  patients  w^ere  such  that 
when  the  Council  of  the  Nightingale  Fund  visited 
the  different  London  hospitals,  with  a  view  of 
making  a  selection  for  the  new  school,  St.  Thomas's 
under  Mrs.  Wardroper 's  rule  was  found  to  be  the 
best  managed  and  most  suitable,  not  including 
those  under  the  care  of  Anglican  Sisterhoods.  ^ 

Although  no  biography  of  Mrs.  Wardroper  has 
been  written,  there  are  many  nurses  who  remem- 
ber her  well,  some  of  whom  have  given  little 
glimpses  of  her  personality.  Thus  Miss  Richards 
has  recalled  her  dignity,  and  her  habit  of  always 
wearing  black  kid  gloves  on  duty,  and  the 
ease  with  which  she  wrote  with  them  on.  Miss 
Isla  Stewart,  the  present  matron  of  St.  Bar- 
tholomew's hospital,  has  told  of  the  feelings  of 
awe  with  which   she  contemplated  Mrs.    Ward- 

>  From  private  sources  through  Miss  Diana  Kimber. 


iQo  A  History  of  Nursing 

roper  when,  one  time,  visiting  the  hospital  with 
her  father,  they  had  some  occasion  for  conversa- 
tion, and  Miss  Stewart  wondered  how  her  father 
could  be  so  self-possessed  while  talking  to  a  woman 
in  such  an  exalted  position,  who  seemed  little  less 
august  than  the  Queen  herself.  Mrs.  Strong  in 
1901  wrote: 

For  Mrs.  Wardroper  I  would  like  to  say  one  word. 
The  single-handed  combat  which  she  undertook  with 
the  general  bad  condition  and  the  ignorance  which  pre- 
vailed at  that  time  in  the  nursing  world,  was  being  nobly 
fought  when  Miss  Nightingale,  in  search  of  a  hospital 
wherein  to  establish  a  school  for  the  training  of  nurses, 
came  upon  and  recognised  the  good  work  being  done 
by  Mrs.  Wardroper  and  chose  St.  Thomas's  hospital 
as  the  centre  of  her  operations.^ 

Mrs.  Wardroper  remained  the  head  of  the  Night- 
ingale school  for  many  years,  and  Miss  Nightingale 
herself  has  left  the  following  memorial,  which 
gives  an  inimitable  picture  of  her : 

One  has  passed  away  without  noise,  without  crown 
or  sceptre  of  martyrdom,  who  was  the  pioneer  of  hos- 
pital nursing — the  first  lay  hospital  matron,  at  least 
of  a  great  public  hospital — who  was  a  gentlewoman. 
Her  kingdom  was  that  of  the  sick.  No  public-press 
heroine  was  she,  yet  the  countless  sick  will  bless  her 
name  though  they  never  heard  it;  and  she  opened  a 
new  calling  for  women  of  all  classes,  the  nursing  insti- 
tutions for  the  poor.  She  did  this,  a  great  work, 
for  her  country  and  her  sovereign — thrice  blessed  to 

1  "  The  Preparatory  Instruction  of  Nurses,"  Transactions, 
Third  International  Congress  of  Nurses,  Buffalo,  1901. 


The  Nightingale  School  for  Nurses   191 

those  for  whom  it  initiated  a  divine  Hfe  of  common- 
sense  in  nursing.  No  Mrs.  Gamp  could  live  in  her 
neighbourhood;  Mrs.  Gamp  was  extinct  forever.  She 
was  soon  gladly  acknowledged  by  the  doctors  as  their 
chief  in  nursing.  She  led  a  hard  life,  but  never  pro- 
claimed it.  What  she  did  was  done  silently.  No 
herald  chanted  her  praises. 

The  state  of  what  was  by  ignorance  called  nurs- 
ing when  she  began  hospital  work,  with  the  miserable 
state,  morally  and  technically,  of  the  nurse,  would 
scarcely  now  be  credited.  Did  one  who  knew  it 
attempt  to  describe  it,  she  would  be  by  a  universal 
jury  of  her  fellows  found  guilty  of  exaggeration.  .  .  . 

I  saw  her  first  in  October,  1854,  when  the  expedition 
of  nurses  was  sent  to  the  Crimean  War.  She  had  been 
then  nine  months  matron  of  the  great  hospital  in 
London  of  which  for  thirty-three  years  she  remained 
head  and  reformer  of  the  nursing.  Training  was 
then  unknown;  the  only  nurse  worthy  of  the  name 
that  could  be  given  to  that  expedition,  though  several 
were  supplied,  was  a  "Sister"  who  had  been  pensioned 
some  time  before,  and  who  proved  invaluable.  I 
saw  her  next  after  the  conclusion  of  the  Crimean 
War.  She  had  already  made  her  mark:  she  had 
weeded  out  the  inefficient,  morally  and  technically; 
she  had  obtained  better  women  as  nurses;  she  had 
put  her  tmger  on  some  of  the  most  flagrant  blots, 
such  as  the  night  nursing,  and  where  she  laid  her 
finger  the  blot  was  diminished  as  far  as  possible,  but 
no  training  had  yet  been  thought  of. 

All  this  led  to  her  being  chosen  to  carry  out,  in  the 
hospital  of  which  she  was  matron,  the  aim  in  the  train- 
ing of  nurses  of  the  Nightingale  Fund  which  had  then 
been  subscribed.     She  was   named  first  superinten- 


192  A  History  of  Nursing 

dent  of  the  school,  and  continued  such  for  27  years, 
until  her  retirement  in  1887.  That  school  under  her 
has  been  more  or  less  the  model  of  all  the  subsequent 
nurse  training  schools,  of  which  now  nearly  every 
considerable  hospital,  and  many  an  inconsiderable, 
has  its  own,  but  they  chiefly  train  for  themselves; 
she,  as  head  of  the  Nightingale  school,  trained  for 
many  other   hospitals   and  infirmaries. 

The  principles  of  this  school  may  be  shortly  said 
to  be  as  follows:  (i)  That  nurses  should  have  their 
technical  training  in  hospitals  specially  organised  for 
this  purpose.  (2)  That  they  should  live  in  a  "home" 
fit  to  form  their  moral  life  and  discipline.  The  school 
under  this  lady  was  opened  at  the  old  St.  Thomas's, 
near  London  Bridge,  in  i860.  St.  Thomas's  and  the 
Nightingale  school  were  removed  to  the  Surrey  Gar- 
dens in  1862,  and  in  1870  to  their  present  abode 
opposite  the  houses  of  Parliament.  ...  At  the  time 
of  her  retirement  upward  of  500  nurses  had  com- 
pleted their  training  and  entered  into  service  on 
the  staff  of  St.  Thomas's  or  other  hospitals,  and  of 
these  over  50  educated  gentlewomen  were  occupying 
important  posts  as  matrons  or  superintendents  of 
nurses  in  hospitals,  infirmaries,  and  nursing  institu- 
tions for  the  poor,  and  not  only  in  the  United  King- 
dom, but  also  abroad. 

It  is  difficult  to  describe  the  character  of  such  a 
woman — the  more  so  as  her  praises  were  never 
sounded  in  newspaper  or  book.  .  .  .  Her  power  of 
organisation  or  administration,  her  courage,  and 
discrimination  in  character,  were  alike  remarkable. 
She  was  straight for^^ard,  true,  upright.  She  was 
decided.  Her  judgment  of  character  came  by  intui- 
tion, at  a  flash,  not  the  result  of  much  weighing  and 


The  Nightingale  School  for  Nurses  193 

consideration;  yet  she  rarely  made  a  mistake,  and 
she  would  take  the  greatest  pains  in  her  written 
delineations  of  character  required  for  record,  writing 
them  again  and  again  in  order  to  be  perfectly  just, 
not  smart  or  clever,  but  they  were  in  excellent  lan- 
guage. She  was  free  from  self-consciousness:  nothing 
artificial  about  her.  "She  did  nothing  because  she 
was  being  looked  at,  and  abstained  from  nothing 
because  she  was  looked  at."  Her  whole  heart  and 
mind,  her  whole  life  and  strength  were  in  the  work 
she  had  undertaken.  She  never  went  a-pleasuring, 
seldom  into  society  Yet  she  was  one  of  the  wittiest 
people  one  could  hear  on  a  summer's  day,  and  had 
gone  a  great  deal  into  society  in  her  young  unmarried 
life.  She  was  left  a  widow  at  42  with  a  young  family. 
She  had  never  had  any  training  in  hospital  life.  There 
was  none  to  be  had.  Her  force  of  character  was 
extraordinary.  Her  word  was  law.  For  her  thoughts, 
words,  and  acts  were  all  the  same.  She  moved  in 
one  piece.  She  talked  a  great  deal,  but  she  never 
wasted  herself  in  talking:  she  did  what  she  said. 
Some  people  substitute  words  for  acts:  she  never. 
She  knew  what  she  wanted,  and  she  did  it.  She 
was  a  strict  disciplinarian;  very  kind,  often  affec- 
tionate, rather  than  loving.  She  took  such  an  in- 
tense interest  in  everything,  even  in  things  matrons 
do  not  generally  consider  their  business,  that  she 
never  tired. 

She  had  great  taste  and  spent  her  own  money  (for 
the  hospital).  She  was  a  thorough  gentlewoman, 
nothing  mean  or  low  about  her;  magnanimous  and 
generous,  rather  than  courteous. 

And  all  this  was  done  quietly.  Of  late  years  the 
great  nursing  work  has  been  scarred  by  fashion  on 


194  A  History  of  Nursing 

one  side,  and  by  mere  money-getting  on  the  other — 
two  catastrophes  sure  to  happen  when  noise  is  sub- 
stituted for  silent  work.  Few  remember  her  in 
these  express-train  days,  dashing  along  at  60  years 
in  a  day.  "A  perfect  w^oman,  nobly  planned,  to  warn, 
to  comfort,  and  command";  comfort  not  in  the 
present  meaning  of  comfortable,  easy-chair  life,  but 
comfort  in  the  good  old  meaning  of  "be  strong  with 
me." 

And  so,  dear  Matron,  as  thou  wast  called  so  many 
years,  we  bid  thee  farewell,  and  Godspeed  to  His 
Higher  world.   .   .   .^ 

So  marked  a  type  of  the  conscientious  dicta- 
tor and  autocrat  as  this  character-picture  shows 
would  obviously  and  necessarily  be  out  of  touch 
with  many  modem  tendencies.  Mrs.  Wardroper 
was  the  perfect  example  of  the  old-fashioned 
autocratic,  military  matron,  who,  perhaps  through 
the  necessity  of  ruling  severely  in  most  cases,  neg- 
lected the  art  of  treating  those  under  her  as  her 
equals  even  when  they  were  so.  She  was  often 
severe  and  hard  when  it  was  unnecessary,  so  that 
some  of  the  gentlewomen  who  worked  under  her 
could  not  speak  of  her  manner  without  resent- 
ment. She  was  a  convinced  individualist;  be- 
lieved in  class  lines,  and  aimed  at  the  preservation 
of  fixed  status;  wished  the  Nightingale  nurses 
to  move  in  a  circle  by  themselves,  and  regarded 
the  earliest  movements  toward  a  more  democratic 

»  "  The  Reform  of  Sick  Nursing,  and  the  late  Mrs. 
Wardroper."  By  Florence  Nightingale.  British  Medical 
Journal,     Dec.  31,  1892. 


The  Nightingale  School  for  Nurses   195 

order  with  the  most  intense  disapprobation.  Miss 
Nightingale  shared  these  views,  to  a  certain  extent 
at  least,  though  it  is  always  well  to  remember 
that  we  cannot  tell  how  she  would  have  felt  toward 
organisation  had  she  been  able  to  continue  her 
active  life.  Mrs.  Wardroper  was  undoubtedly, 
on  some  lines,  conservative  even  to  narrowness; 
and  when,  in  England,  the  first  steps  were  taken 
toward  a  professional  equality  and  fraternity  in 
the  formation  of  the  Royal  British  Nurses'  Asso- 
ciation (whose  history  will  be  considered  in  an- 
other volume),  designed  to  bring  nurses  from  all 
schools  together  for  mutual  stimulus,  protection^ 
and  progress,  —  a  thing  which  was  until  then 
unheard-of  in  the  evolution  of  nursing  orders, — 
Mrs.  Wardroper  regarded  the  movement  as  dan- 
gerous and  subversive  of  proper  standards,  and 
opposed  it  with  all  her  power.  1  Miss  Nightin- 
gale, too,  disapproved,  and  urged  the  Nightingale 
nurses  not  to  enter  into  this  unknown,  and, 
as  it  seemed  then,  revolutionary  union,  which 
threatened  to  undermine  the  authority  and  re- 
strict the  sphere  of  the  matron,  and  to  cut  loose 
the  ties  which  had  heretofore  kept  the  nurse 
closely  related  to  her  school. 

Anomalous  as  such  views  seem  to-day,  they 
were  very  natural  then,  for  the  power  of  ideas 
made  the  dependency  of  the  convent  seem  a  hard 

«  St.  Thomas's  nurses  have  never  formed  an  association, 
but  have  an  annual  reunion  at  the  school  and  are  encouraged 
to  keep  in  touch  with  it. 


196  A  History  of  Nursing 

thing  for  women  to  break  away  from,  and  the 
forms  of  the  convent  still  lay  only  a  very  short 
distance  in  the  past  of  nursing. 

It  was,  possibly,  with  some  such  conservative 
idea  in  mind  that  Miss  Nightingale  wrote  to  nurses 
these  words : 

Esprit  de  corps  should  be  encouraged.  It  is  a 
great  help  to  think,  "If  I  do  this  I  shall  be  a  disgrace 
to  my  training  school" — "If  I  do  that  I  shall  be  an 
honour  to  it."  Let  nurses  be  proud  of  their  alma 
mater.  Let  them  think  their  own  training  school 
and  their  own  doctors  the  first  in  the  world.  Let 
there  be  a  friendly  rivalry  with  other  hospitals,  and 
never  try  to  fuse  all  nurses  into  one  mass — one  in- 
distinguishable mass — of  all  training  schools  or 
hospitals.  If,  however,  there  has  been  little  or  no 
discipline  in  the  training  school,  then  the  esprit  de 
corps  will  tend  to  harm,  and  not  to  good.^ 

The  benefit  of  esprit  de  corps  is  more  keenly 
realised  than  ever,  but  we  no  longer  feel  that 
widespread  organisation  fuses  all  nurses  in  an 
indistinguishable  mass.  Solidarity,  that  word 
that  means  so  much  to-day,  had  no  force  for  the 
members  of  the  older  training  schools. 

It  is  also  well  known  that  Miss  Nightingale  and 
the  matrons  of  that  older  school  have  not  sup- 
ported the  modern  movement  for  legal  status, 
though  with  Miss  Nightingale  this  arose  from  a 
belief  that  it  would  check  progress.     She  wrote : 

1  Quain's  Dictionary  of  Medicine,  ed.  of  1894.  Art.,  Train' 
ing  of  Nurses. 


The  Nightingale  School  for  Nurses   197 

Nursing  is,  above  all,  a  progressive  calling.  Year 
by  year  nurses  have  to  learn  new  and  improved 
methods,  as  medicine  and  surgery  and  hygiene  im- 
prove. Year  by  year  nurses  are  called  upon  to  do 
more,  and  better,  what  they  have  done.  It  is  felt 
to  be  impossible  to  have  a  public  register  that  is  not 
a  delusion.  Further,  year  by  year  nursing  needs  to 
be  more  and  more  of  a  moral  calling.^ 

It  is,  however,  possible  that,  were  Miss  Nightin- 
gale still  out  in  the  world  of  nurses,  she,  too,  might 
regard  State  examination  not  as  a  public  bureau 
for  certifying  the  personal  character  of  nurses  to 
employers  (which  it  could  never  possibly  be) ,  but 
as  a  bulwark  (capable,  also,  of  extension) ,  to  pro- 
tect the  fundamentals  of  a  practical  training  and 
teaching  which  she  with  such  rare  revolutionary 
skill,  courage,  and  success  built  up  after  having 
doomed  the  whole  bad  system  then  existing  to 
extinction.  We  will  recur  to  this  later  in  con- 
sidering her  writings. 

While  in  the  principles  of  nursing,  sanitation, 
hygiene,  and  enlightened  humanitarianism  Miss 
Nightingale  may  be  confidently  regarded  as,  hu- 
manly speaking,  infallible,  there  is  no  lessening 
of  the  deep  reverence  in  which  she  is  held  to  assume 
that  she  is  not  always  so  when  judging  of  the 
changing  social  adjustments  under  which  nurses, 
following  an  inexorable  compulsion,  have  been 
reorganising  their  living  and  working  conditions. 

The  time  of  training  of  the  Nightingale  school 

>  Art.,  Nursing  the  Sick.  Quain,  1894,  Art.,  Training  of 
Nurses. 


198  A  History  of  Nursing 

was  one  year.  The  pupils  were  called  proba- 
tioners during  the  entire  time.  At  the  end  of  the 
year,  if  their  record  was  satisfactory,  they  were 
entered  in  the  school  register  as  certified  nurses, 
to  be  recommended  for  employment  accordingly. 
The  training  was  now  usually  considered  com- 
plete, but  the  nurse  did  not  leave  her  school  and 
become  independent.  On  her  entrance  the  pro- 
bationer had  agreed  to  remain  in  the  service  of 
the  school  for  three  full  years  after  the  first  year  of 
training:  this  was,  in  effect,  a  four  years'  course, 
except  that  class  and  lecture  instruction  had 
ceased  at  the  end  of  the  first  year.  The  nurses 
received  certain  payments  in  money  and  clothing, 
and  after  the  four  years'  service  was  ended  the 
Nightingale  committee  secured  hospital  positions 
for  them  on  salary;  but  the  nurses  were  not  al- 
lowed to  make  engagements  except  through  the 
committee,  nor  to  terminate  one  except  after  three 
months'  notice  to  the  committee.  By  this  ar- 
rangement the  school  carried  out  its  design  of 
training  women  for  hospital  work  preeminently. 

It  is  interesting  to  know  that  the  Nightingale 
school  for  many  years  did  not  give  certificates  to 
its  pupils.     Miss  Nightingale  on  this  point  said: 

We  do  not  give  the  women  a  printed  certificate,  but 
simply  enter  the  names  of  all  certificated  nurses  in 
the  Register  as  such.  This  was  done  to  prevent  them 
in  the  case  of  misconduct  from  using  their  certificate 
improperly.! 

1  Art.  in  Accounts  and  Papers,  Metropol.  Workhouses,"  1867. 


The  Nightingale  School  for  Nurses  199 

This  detail  was  one  which  later  became  out  of 
harmony  with  public  sentiment,  and  certificates 
are  now  granted  at  the  end  of  the  three  years' 
course  to  special  probationers,  and  after  four 
years  to  the  hospital  nurses.  Long  after  all  the 
other  equally  important  English  hospitals  had 
lengthened  to  three  years  the  period  during  which 
the  nurse  was  in  training,  and  before  she  received 
her  certificate,  St.  Thomas's  retained  its  one  year, 
but  at  the  present  time  its  term  of  training,  like 
the  others,  is  placed  on  the  higher  basis.  St. 
Thomas's  still  recognises  two  classes  of  students — 

special  or  paying  probationers  [who  must  be  gen- 
tlewomen, and  who  come]  with  the  express  object 
of  entering  the  nursing  profession  permanently  by 
eventually  filling  superior  situations  in  public  hos- 
pitals and  infirmaries,  or  by  nursing  the  poor  at  their 
own  homes  under  some  organised  system  of  district 
nursing;  who  pay  a  fee  of  ;^3o  [about  $150] 
and  agree  to  remain  for  two  years'  service  after  the 
first,  which  is  still  regarded  as  the  year  of  training: 
probationers,  or  women  desirous  of  working  as  hos- 
pital nurses.  Such  probationers  pay  no  fee,  but  con- 
tinue to  receive  certain  wages  and  clothing,  with 
instruction,  during  the  first  year,  and  agree  to  remain 
for  three  further  years  of  service,  on  salary.^ 

As,  contrary  to  the  earlier  custom,  these  two 
classes  of  pupils  now  receive  certificates,  and  as 
these  are  not  given  to  them  until  the  termination 
of,  respectively,  the  three  and  four  years'  course 

»  Regulations. 


200  A  History  of  Nursing 

to  which  they  bind  themselves,  this  period  may 
be  regarded  as  a  time  of  pupilage,  or  training  term 
of  three  and  four  years.  ^ 

The  theoretical  teaching  was  in  the  form  of 
lectures,  prescribed  reading,  and  examination  by 
the  medical  lecturers,  but  before  all  else  Miss 
Nightingale  insisted  upon  the  cultivation  of  the 
obser^'ation  and  reflection  by  written  notes  of 
cases,  of  work  and  procedures.     She  says : 

To  train  to  train  needs  a  system  —  a  systematic 
course  of  reading,  laid  down  by  the  medical  instructor, 
hours  of  study  (say  two  afternoons  a  week),  regular 
examinations  by  him,  themselves  cultivating  their 
own  powers  of  expression  in  answering  him. 

Those  who  have  to  train  others  are  the  future 
leaders,  and  this  must  be  borne  in  mind  during  their 
year's  training. 

Careful  notes  of  lectures,  careful  notes  of  type 
cases,  and  of  cases  interesting  from  being  not  types 
but  unusual,  must  be  kept  by  them;  their  powers  of 
observation  must  be  improved  in  every  way. 

To  illustrate  the  cases  they  are  nursing  in  the 
wards,  descriptions  of  these  cases  must  be  pointed 
out  to  them  at  the  time  in  the  books  in  their  library. 

They  must  be  encouraged  to  jot  down  aften\-ards, 
but  while  still  fresh  in  the  memory,  the  remarks 
made  by  the  physicians  and  surgeons  to  their  students 
in  going  their  rounds. 

They  must  be  taught,  both  by  the  ward  Sisters  and 

>  St.  Thomas's  hospital  does  not  give  its  nurses  a  pension, 
but  provides  many  permanent  positions,  with  good  con- 
ditions. The  nurses  average  ten  years'  stay  there.  Blue 
Book,  "  Metropolitan  Hospitals,"  iSgo,  p.  91. 


The  Nightingale  School  for  Nurses  201 

the  medical  instructor,  to  know  not  only  symptoms 
and  what  is  to  be  done,  but  to  know  the  "reason 
why"  of  such  symptoms,  and  why  such  and  such  a 
thing  is  done.  Else,  how  can  they  train  others  to 
know   the    "reason   why"? 

Time  must  be  given  them  for  this,  otherwise  they 
are  too  likely  to  degenerate  into  drudgery  in  the 
wards. 

They  must  write  out  their  jottings  afterward  in 
the  home.i 

While  the  attitude  of  the  medical  profession 
towards  the  new  teaching  must  have  been  on  the 
whole  cordial  (or  it  could  not  have  been  carried 
on),  yet  the  perennial  objector  did  not  fail  to  rise 
up  in  the  person  of  Dr.  La  Garde,  who,  in  an  ad- 
dress on  "  Nursing  Sisterhoods  and  Hospital  Schools 
for  Nurses"  regarded  with  alarm  this  dangerous 
tendency  to  communicate  professional  knowledge 
of  a  technical  sort  to  the  nurse,  whose  proper 
standing  he  summed  up  as  follows : 

A  nurse  is  a  confidential  servant;  but  still  only  a 
servant.  She  should  be  middle-aged  when  she  be- 
gins nursing;  and  if  somewhat  tamed  by  marriage 
and  the  troubles  of  a  family  so  much  the  better. 

The  medical  instruction  of  the  early  schools, 
however,  was,  in  the  opinion  of  Dr.  Gill  Wylie,  who 
visited  St.  Thomas's  in  1872,  not  alarmingly  com- 
plicated. He  wrote  an  account  of  his  visit  and 
impressions  which  is  very  lifelike : 

»  From  the  article  on  training  in  Accounts  and  Papers, 
"Metropolitan  Workhouses,"  1867. 


202  A  History  of  Nursing 

During  the  three  weeks'  stay  in  London,  my  lodg- 
ings were  in  St.  Thomas's  Hospital.  Mrs.  Wardroper 
has  been  matron  of  this  hospital  of  600  beds  for  eight- 
een years.  She  is  also  lady  superintendent  of  the 
Nightingale  training  school  for  nurses,  and  fulfils 
the  varied  duties  of  these  positions  in  the  most 
satisfactory  manner.  Although  much  occupied,  she 
was  very  kind  in  giving  me  information,  and  allow- 
ing me  every  advantage  for  studying  the  system  of 
training. 

The  arrangements  for  the  nursing  staff  are  as  fol- 
lows: There  are  in  all  16  hospital  Sisters  or  head 
nurses,  one  of  whom  acts  as  superintendent  of  night 
nurses  and  one  as  matron's  assistant.  There  are 
fifty-four  nurses  and  three  nursemaids;  to  five  of  the 
head  nurses  are  assigned  two  wards  each;  to  seven, 
one  each,  and  there  is  one  Sister  for  the  infectious 
block;  for  every  large  ward  there  is  one  day  nurse 
and  one  night  nurse. 

There  are  23  wardmaids,  and  for  the  cleaning  of 
the  stairs  and  corridors,  and  the  general  work  out- 
side the  wards,  14  scrubbers.  Such  nurses  as  have 
charge  of  a  ward  sleep  in  their  own  rooms  adjoining 
their  respective  wards ;  and  the  other  nurses  and  ward- 
maids  sleep  on  the  attic  floor  of  the  block  in  which 
their  respective  wards  are  situated.  Each  nurse  has 
a  bedroom  to  herself. 

The  probationers  are  employed  as  assistant  nurses 
under  the  immediate  direction  of  the  head  nurses. 
As  a  general  rule  two  are  assigned  to  each  medical  and 
surgical  ward;  occasionally,  according  to  the  neces- 
sities of  the  case,  three  to  one  ward  and  one  to  an- 
other; they  are  not  employed  in  the  infectious  wards. 
They  pass,   during  the  year's  training,   successively 


The  Nightingale  School  for  Nurses  203 

through  all  the  different  wards,  except  those  of  the 
infectious  block.  Those  who  are  qualified  are  em- 
ployed to  take  the  places  of  the  other  nurses  during 
illness  or  temporary  absence. 

From  this  it  is  seen  that  to  about  thirty  patients 
there  is  one  head  nurse,  one  day  nurse,  one  night 
nurse,  two  probationer-assistants,  and  one  ward  maid. 

As  to  the  instructions  given  outside  the  wards,  a 
few  lectures  are  delivered  each  season  by  Dr.  Pea- 
cock, on  principles  of  medicine;  by  Mr.  Le  Gros  Clark, 
on  surgical  subjects;  and  Dr.  Bernays,  on  chemistry 
and  the  properties  of  air  and  light.  All  of  these  are 
men  of  reputation,  being  visiting  physicians  to  the 
hospital  and  professors  in  the  medical  college.  While 
the  lectures  are  being  delivered  the  probationers 
take  notes,  and  afterwards  write  out  the  lectures.  I 
examined  eight  or  nine  of  the  best  written.  In  most 
of  them  the  subjects  were  treated  in  the  simplest 
style.  Mr.  Clark  himself  told  me  that  he  merely 
gave  them  a  talk,  telling  them  what  they  should  not 
do,  rather  than  anything  else.  The  lectures  are  too 
few  in  number  and  not  at  all  systematised.  It  seems 
to  me  that  to  take  a  woman  or  man  at  the  age  of  30 
with  only  a  common  education  as  a  basis,  and  teach 
them  science  by  lectures,  is  a  doubtful  experiment; 
and  that  if  attempted  at  all  it  should  be  by  men  who 
have  the  time  to  make  the  course  of  instruction  a 
special  study. ^ 

The  general  features  of  hospital  life  and  nursing 
arrangements  at  the  time  that  Miss  Nightingale's 

»  Report  to  the  Training  School  Committee  of  Bellevue  Hos- 
Jyital,  1872. 


204  A  History  of  Nursing 

reformation  was  set  in  motion  are  very  graphically 
described  in  the  British  Medical  Journal  in  a  series 
of  reports  by  a  special  commissioner,  who  com- 
pared the  conditions  of  his  day  (1874)  with  those 
of  twenty  years  earlier.  Then  (1854)  the  average 
metropolitan  hospital  had  three  classes  of  nurses : 
head  nurses,  nurses,  under  nurses.  It  was  pos- 
sible, under  the  system  of  promotion  prevailing, 
for  the  under  nurses  to  become  head  nurses.  There 
was  no  uniform  dress,  and  (what  modem  pupil- 
nurses  would  do  well  to  note)  besides  a  salary  each 
nurse  received  eight  shillings  a  week  in  place 
of  board.  They  cooked  their  food  (which  they 
bought  for  themselves)  and  ate  their  meals  in  the 
ward  kitchens  or  scullery.  The  assistant  nurses 
had  the  cooking  to  do  for  the  head  nurses  and  the 
patients  as  well  as  for  themselves.  The  night 
nurses  were  on  duty  from  10  p.  m.  to  i  p.  m.,  or 
fifteen  hours.  They  occasionally  had  a  leave  of 
absence  for  afternoon  and  evening,  but  were  on 
duty  at  ten  as  usual ;  on  these  occasions  being  up 
for  about  forty  hours  at  a  stretch.  The  matron 
was  someone  who  perhaps  had  been  nurse  or 
house-keeper  to  some  influential  governor.  She 
is  described  as  having  been  usually  a  stout  lady 
with  an  authoritative  voice  and  wonderful  cap. 
The  head  nurses  were,  in  their  wards,  practically 
independent  of  her,  and  their  loyalty  was  prin- 
cipally shown  by  imitating  her  cap.  But  that 
there  were  personalities  of  value  among  the  old- 
style  nurses  is  recorded  by  Sir  James  Paget,  who 


The  Nightingale  School  for  Nurses  205 

has  left  recollections  of  some  of  the  old  nurses  at 
St.  Bartholomew's. 

*'  It  is  true  [he  writes]  that  even  fifty  years  ago  there 
were  some  excellent  nurses,  especially  among  the 
Sisters  in  the  medical  wards,  where  everything  was  more 
gentle  and  orderly  than  in  the  surgical.  There  was  an 
admirable  Sister  Hope,  who  had  her  leg  amputated 
and  then  devoted  her  life  to  nursing  there.  .  .  . 

An  old  Sister  Rahere  was  the  chief  among  them, 
stout,  ruddy,  positive,  very  watchful.  She  once 
taught  an  erring  house  surgeon  where  and  how  to  com- 
press a  posterior  tibial  artery.  She  could  always 
report  correctly  the  progress  of  a  case;  and  from  her 
wages  she  saved  all  she  could  and  left  it  in  legacy  to 
the  hospital.  * 

The  customs  relating  to  board  and  wages  were 
of  long  standing,  but  had  varied  a  little  in  different 
hospitals.  St.  Bartholomew's  had  paid  its  Sisters 
an  average  of  sixteen  shillings  a  week,  and  they 
provided  their  own  food.  The  nurses  received 
one  shilling  and  twelve  ounces  of  bread  daily. 
St.  Thomas's  gave  its  Sisters  £2,"]  a  year;  the 
nurses  had  9  shillings  7  pence  a  week,  and  beer. 
Guy's  hospital  paid  its  Sisters  and  nurses  better 
than  any,  but  at  none  of  the  three  did  they  receive 
any  food  beyond  that  mentioned,  nor  were  their 
wages  increased  by  length  of  service.  At  St. 
George's  all  the  nurses  were  allowed  six  pounds  of 
bread  a  week,  one  half  pint  of  milk  and  two  pints 

>  Memoirs   and    Letters    of   Sir   James    Paget,  Longmans, 
Green  &  Co.,  London,  1901,  p.  353. 


2o6  A  History  of  Nursing 

of  beer  daily,  and  one  shilling  a  day  to  buy  addi- 
tional food  (board  and  wages) .  ^ 

The  example  of  the  Nightingale  school,  tri- 
umphantly made,  was  in  time  followed  by  every 
other  English  hospital  of  importance.  One  by 
one  they  gave  up  the  old  system  of  nursing  for  the 
new,  and  the  English  colonies  and  the  United 
States  followed  the  lead.  As  time  w^ent  on  it  was 
not  always  easy  to  keep  the  ranks  recruited  in 
sufficient  numbers  to  fill  all  the  demands  of  hos- 
pital service,  and  a  feature  peculiar  to  English 
hospital  life  appeared  in  the  "lady  probationer." 
The  lady  probationer  came  for  a  term  of  from 
three  to  six  months'  training,  paying  a  fee  for  her 
tuition,  and  had  rather  special  privileges  in  that 
she  was  allowed  to  slip  over  more  laborious  and 
routine  parts  of  ward  work  and  to  attain  superior 
posts  by  virtue  of  her  education,  intelligence,  and 
social  position  instead  of  as  the  result  of  the  long, 
hard  time  of  training.  She  was  only  a  transient 
figure,  and  has  to-day  almost  entirel]/  disappeared 
from  English  hospitals. ^ 

1  History  of  the  Middlesex  Hospital,  p.  117. 

2  See  evidence  on   "  paying  probationers  "    in  Blue  Book, 
Metropolitan  Hospitals,  1890,  p.  393. 


Nightingale  Home  and  Training  School  for  Nurses,  St.  Thomas's  Hospital 


CHAPTER  V 

MISS  NIGHTINGALE'S  WRITINGS 

GREAT  as  Miss  Nightingale  was  as  a  nurse, 
her  nursing  reflected  only  a  part  of  her 
genius.  She  was,  perhaps,  even  greater  as  a 
teacher,  and  without  a  doubt  greatest  as  a  sani- 
tarian. Though  it  was  by  her  nursing  that  she 
seized  and  held  the  hearts  and  imaginations  of 
men — so  that  those  who  know  nothing  further  of 
her  know  that  she  was  the  heroine  of  the  Crimea 
and  the  reformer  of  nursing, — it  is  the  intellectual 
quality  of  her  deep  insight  into  problems  of  health 
that  keeps  her  work  and  will  always  keep  it  fresh 
and  vivid.  It  is  not  possible  to  study  her  writ- 
ings without  being  strongly  stirred  by  her  ardent 
realisation  of  all  that  makes  for  health.  She  was 
an  enthusiast  for  health  and  happiness.  Said 
Dr.  Blackwell,  "  To  her  chiefly  I  owe  the  awaken- 
ing to  the  fact  that  sanitation  is  the  supreme  goal 
of  medicine,  its  foundation  and  its  crown."  In 
considering  her  practical  and  technical  knowledge, 
so  extensive,  so  minute,  so  exact,  and  abos^e  all 
so  intelligent  is  it  found  to  be  that  it  is  perhaps 
not  too  much  to  call  her  the  foremost  sanitarian 

207 


2o8  A  Histoty  of  Nursing 

of  her  age,  as  uniting  in  a  rare  measure  technical 
knowledge  with  organising  capacity.  Practical 
hygiene  underlay  all  her  teachings  throughout  her 
long  life,  beginning  with  her  individual  \-isits  in 
the  cotta2:es  near  her  country  home. 

A  very  remarkable  example  of  the  originality 
of  this  teaching  is  her  Notes  on  Nursing;  Wliat 
It  Is,  and  What  It  Is  Not.  In  this  unrivalled 
monograph  she  does  not  concern  herself  with  so 
much  as  a  glance  at  the  carrying  out  of  "  orders  "  in 
the  application  of  treatment,  nor  describe  a  single 
method  of  technical  procedure,  nor  hint  at  the 
relation  of  the  nurse  to  the  patient,  the  physician, 
the  family,  nor  describe  the  symptoms  of  a  single 
disease,  nor  outline  the  special  nursing  care  of  any 
special  case.  That  which  makes  this  book  an  im- 
mortal classic  is  its  teaching  of  sanitary  truths  and 
principles  as  applied  in  the  care  of  sickness,  and 
of  a  boundless  and  exquisite  humaneness  towards 
the  patient;  principles  which  will  never  change, 
while  procedures,  professional  etiquette,  and 
methods  will.  In  its  presentation  of  these  truths 
and  the  practical  application  made  of  them,  it 
stands  unique,  unapproached,  and  complete. 
In  selecting  quotations  from  the  Notes  we  are 
impressed  afresh  with  its  rare  characteristics, 
and  are  impelled  to  urge  upon  every  woman — • 
not  only  every  nurse,  but  every  woman  who  reads 
these  words — to  possess  herself  of  it  and  make  its 
teaching  a  part  of  her  mental  equipment. 

In  watching  disease,  both  in  private  houses  and  in 


Miss  Nightingale's  Writings      209 

public  hospitals,  the  thing  which  strikes  the  experi- 
enced observer  most  forcibly  is  this,  that  the  symptoms 
or  the  sufferings  generally  considered  to  be  inev- 
itable, and  incident  to  the  disease,  are  very  often  not 
symptoms  of  the  disease  at  all,  but  of  something  quite 
different — of  the  want  of  fresh  air,  or  of  light,  or  of 
warmth,  or  of  quiet,  or  of  cleanliness,  or  of  punctuality 
and  care  in  the  administration  of  diet,  of  each  or  of  all 
of  these.  And  this  quite  as  much  in  private  as  in 
hospital  nursing. 

The  reparative  process  which  Nature  has  instituted 
and  which  we  call  disease,  has  been  hindered  by  some 
want  of  knowledge  or  attention,  in  one  or  in  all  of 
these  things,  and  pain,  suffering,  or  interruption  of  the 
whole  process  sets  in. 

If  a  patient  is  cold,  if  a  patient  is  feverish,  if  a  pa- 
tient is  faint,  if  he  is  sick  after  taking  food,  if  he  has 
a  bed-sore,  it  is  generally  the  fault,  not  of  the  disease, 
but  of  the  nursing. 

I  use  the  word  nursing  for  want  of  a  better.  It  has 
been  limited  to  signify  little  more  than  the  adminis- 
tration of  medicines  and  the  application  of  poultices. 
It  ought  to  signify  the  proper  use  of  fresh  air,  light, 
warmth,  cleanliness,  quiet,  and  the  proper  selection 
and  administration  of  diet — all  at  the  least  expense  of 
vital  power  to  the  patient. 

It  has  been  said  and  written  scores  of  times  that 
every  woman  makes  a  good  nurse.  I  believe,  on  the 
contrary,  that  the  very  elements  of  nursing  are  all 
but  unknown.   .   .   . 

The  art  of  nursing,  as  now  practised,  seems  to  be 
expressly  constituted  to  unmake  what  God  had  made 
disease  to  be,  viz  ,  a  reparative  process.  ...  If  we 
were  asked.  Is  such  or  such  a  disease  a  reparative 

VOL.  II. — 14. 


2IO  A  History  of  Nursing 

process?  Can  such  an  illness  be  unaccompanied  with 
suffering?  Will  any  care  prevent  such  a  patient  from 
suffering  this  or  that? — I  humbly  say,  I  do  not  know. 
But  when  you  have  done  away  with  all  that  pain  and 
suffering,  which  in  patients  are  the  symptoms,  not  of 
their  disease,  but  of  the  absence  of  one  or  all  of  the 
above-mentioned  essentials  to  the  success  of  Nature's 
reparative  process,  v\'e  shall  then  know  what  are  the 
symptoms  of  and  the  sufferings  inseparable  from  the 
disease.   .   .   . 

.  .  .  The  very  elements  of  what  constitutes  good 
nursing  are  as  little  imderstood  for  the  well  as  for  the 
sick.  The  same  laws  of  health,  or  of  nursing,  for  they 
are  in  reality  the  same,  obtain  among  the  well  as  among 
the  sick.  The  breaking  of  them  produces  only  a  less 
violent  consequence  among  the  former  than  among  the 
latter,  — and  this  sometimes,  not  always.  .  .  .  O  mothers 
of  families,  do  you  know^  that  one  of  every  seven  infants 
in  this  civilised  land  of  England  perishes  before  it  is  one 
year  old  ?  That  in  London  two  in  every  five  die  before 
they  are  five  years  old  ?  And  in  the  other  great  cities 
of  England,  nearly  one  out  of  two  ?  "The  life  duration 
of  tender  babies"  (as  some  Saturn,  turned  analyt- 
ical chemist,  says)  "is  the  most  delicate  test"  of  sani- 
tary conditions.  Is  all  this  premature  suffering  and 
death  necessary?  Or  did  Nature  intend  mothers  to 
be  always  accompanied  by  doctors?  Or  is  it  better 
to  learn  the  pianoforte  than  to  learn  the  laws  which 
subserve  the  preservation  of  offspring?  .   .   . 

The  very  first  canon  of  nursing,  the  first  and  the 
last  thing,  upon  which  a  nurse's  attention  must  be 
fixed,  the  first  essential  to  a  patient,  without  w^hich 
all  the  rest  you  can  do  for  him  is  as  nothing,  with 
which,  I  had  almost  said,  you  may  leave  all  the  rest 


Miss  Nightingale's  Writings      211 

alone,  is  this:  to  keep  the  air  he  breathes  as  pure  as 
the  external  air^  without  chilling  him.  Yet,  what  is  so 
little  attended  to?  Even  where  it  is  thought  of  at 
all,  the  most  extraordinary  misconceptions  reign 
about  it.  Even  in  admitting  air  into  the  patient's 
room  or  ward  few  people  ever  think  where  that  air 
comes  from.  It  may  come  from  a  corridor  into  which 
other  wards  are  ventilated,  from  a  hall  always  un- 
aired,  always  full  of  the  fumes  of  gas,  dinner,  of  vari- 
ous kinds  of  mustiness ;  from  an  underground  kitchen 
sink,  washhouse,  water-closet,  or  even,  as  I  myself 
have  had  sorrowful  experience,  from  open  sewers 
loaded  with  filth;  and  with  this  the  patient's  room 
or  ward  is  aired,  as  it  is  called — poisoned,  it  should 
rather  be  said.  .  .  .  Never  be  afraid  of  open  win- 
dows, then.     People  don't  catch  cold  in  bed.     This  is 

a  popular  fallacy.  .  .  .  Dr.   's   air   test,  if  it 

could  be  made  of  simple  application,  would  be  inval- 
uable to  use  in  every  sleeping-  and  sick-room.    .    .   . 

And  O,  the  crowded  national  school,  where  so  many 
children's  epidemics  have  their  origin,  what  a  tale  an 
air-test  would  tell!  We  should  have  parents  saying, 
and  saying  rightly,  "I  will  not  send  my  child  to  that 
school,  the  air-test  stands  at  'Horrid.'"  And  the 
dormitories  of  our  great  boarding-schools!  Scarlet 
fever  would  be  no  more  ascribed  to  contagion,  but  to 
its  right  cause,  the  air-test  standing  at  "  Foul."  .  .  . 

The  extraordinary  confusion  between  cold  air  and 
ventilation  even  in  the  minds  of  well-educated  people 
illustrates  this.  To  make  a  room  cold  is  by  no  means 
necessary  to  ventilate  it.  Nor  is  it  at  all  necessary, 
to  ventilate  a  room,  to  chill  it.  .  .  .  Another  extra- 
ordinary fallacy  is  the  dread  of  the  night  air.  What 
air  can  we  breathe  at  night  but  night  air?     The  choice 


212  A  History  of  Nursing 

is  between  pure  night  air  from  without  and  foul  night 
air  from  within.  Most  people  prefer  the  latter.  An 
unaccountable  choice.  What  will  they  say  if  it  is 
proved  to  be  true  that  fully  one  half  of  all  the  disease 
we  suflFer  from  is  occasioned  by  people  sleeping  with 
their  windows  shut  ? 


If  a  nurse  declines  to  do  these  things  for  her  patient, 
"because  it  is  not  her  business,"  I  should  say  that 
nursing  was  not  her  calling.  I  have  seen  surgical 
"Sisters,"  women  whose  hands  were  worth  to  them 
two  or  three  guineas  a  week,  down  upon  their  knees 
scouring  a  room  or  hut,  because  they  thought  it  other- 
wise not  fit  for  their  patients  to  go  into.  I  am  far 
from  wishing  nurses  to  scour.  It  is  a  waste  of  power. 
But  I  do  say  that  these  women  had  the  true  nursing 
calling — ^the  good  of  their  sick  first,  and  second  only 
the  consideration  what  it  was  their  "place"  to  do; — 
and  that  women  who  wait  for  the  housemaid  to  do 
this,  or  for  the  charwoman  to  do  that,  when  their  pa- 
tients are  suffering,  have  not  yet  the  making  of  a  nurse 
in  them. 


Is  it  not  living  in  a  continual  mistake  to  look  upon 
diseases,  as  we  do  now,  as  separate  entities,  which 
must  exist,  like  cats  and  dogs,  instead  of  looking 
upon  them  as  conditions,  like  a  dirty  and  a  clean  con- 
dition, and  just  as  much  under  our  own  control,  or 
rather  as  the  reactions  of  a  kindly  nature  against  the 
conditions  in  which  we  have  placed  ourselves? 

I  was  brought  up,  both  by  scientific  men  and  igno- 


Miss  Nightingale's  Writings       213 

rant  women,  distinctly  to  believe  that  small-pox,  for 
instance,  was  a  thing  of  which  there  was  once  a  first 
specimen  in  the  world,  which  went  on  propagating 
itself,  in  a  perpetual  chain  of  descent,  just  as  much 
as  that  there  was  a  first  dog  (or  pair  of  dogs) ,  and  that 
small-pox  would  not  begin  of  itself  any  more  than  a 
new  dog  would  begin  without  there  having  been  a 
parent  dog. 

Since  then  I  have  seen  with  my  own  eyes  and  smelt 
with  my  nose  small-pox  growing  up  in  first  specimens, 
either  in  close  rooms  or  in  overcrowded  wards,  where 
it  could  not  by  any  possibility  have  been  "caught," 
but  must  have  begun. 

Nay,  more,  I  have  seen  diseases  begin,  grow  up, 
and  pass  into  one  another.  Now,  dogs  do  not  pass 
into  cats. 

I  have  seen,  for  instance,  with  a  little  overcrowd- 
ing, continued  fever  grow  up :  and  with  a  little  more, 
typhoid  fever:  and  with  a  little  more,  typhus,  and  all 
in  the  same  ward  or  hut. 

Would  it  not  be  far  better,  truer,  and  more  practi- 
cal, if  we  looked  upon  diseases  in  this  light?  For  dis- 
eases, as  all  experience  shows,  are  adjectives,  not 
noun  substantives. 


There  are  five  essential  points  in  securing  the 
health  of  houses:  i.  Pure  air.  2.  Pure  water.  3 
Efficient  drainage.  4.  Cleanliness.  5.  Light.  God 
lays  down  certain  physical  laws.  Upon  His  carrying 
out  such  laws  depends  our  responsibility  (that  much 
abused  word) ;  for  how  could  we  have  any  responsi- 
bility for  actions  the  results  of  which  we  could  not 
foresee? — ^which  would  be   the    case  if  the  carrying 


2  14  A  History  of  Nursing 

out  of  His  laws  were  not  certain.  Yet  we  seem  to  be 
continually  expecting  that  He  will  work  a  miracle, 
i.  e.,  break  His  own  laws  expressly  to  relieve  us  of 
responsibility. 

5.  A  dark  house  is  always  an  unhealthy  house, 
always  an  unaired  house,  always  a  dirty  house.  Want 
of  light  stops  growth,  and  promotes  scrofula,  rickets, 
etc.,  among  the  children. 

People  lose  their  health  in  a  dark  house,  and  if  they 
get  ill,  they  cannot  get  well  again  in  it. 

Don't  imagine  that  if  you,  who  are  in  charge,  don't 
look  to  all  these  things  yourself,  those  under  you  will 
be  more  careful  than  you  are.  It  appears  as  if  the 
part  of  a  mistress  now  is  to  complain  of  her  servants, 
and  to  accept  their  excuses — not  to  show  them  how 
there  need  be  neither  complaints  made  nor  excuses. 

But  again,  to  look  to  all  these  things  yourself  does 
not  mean  to  do  them  yourself.  "I  always  open  the 
windows,"  the  head  in  cha-ge  often  says.  H  you  do 
it,  it  is  by  so  much  the  better,  certainly,  than  if  it  were 
not  done  at  all.  But  can  you  not  insure  that  it  is 
done  when  not  done  by  yourself'  Can  you  insure 
that  it  is  not  undone  when  your  back  is  turned?  This 
is  what  "being  in  charge"  means.  And  a  very  im- 
portant meaning  it  is,  too.  The  former  only  implies 
that  just  what  you  can  do  with  your  own  hands  is 
done.  The  latter,  that  what  ought  to  be  done  is 
always  done. 

Wise  and  humane  management  of  the  patient  is  the 
be-t  safeguard  against  infection. 


Miss  Nightingale's  Writings       215 

There  are  not  a  few  popular  opinions  in  regard 
to  which  it  is  useful  at  times  to  ask  a  question  or 
two.  For  example,  it  is  commonly  thought  that 
children  must  have  what  are  commonly  called  "chil- 
dren's epidemics,"  "current  contagions,"  etc.  —  in 
other  words,  that  they  are  born  to  have  measles, 
whooping-cough,  perhaps  even  scarlet  fever,  just  as 
they  are  born  to  cut  their  teeth,  if  they  live. 

Now,  do  tell  us,  why  must  a  child  have  measles? 

Oh,  because,  you  say,  we  cannot  keep  it  from  infec- 
tion: other  children  have  measles,  and  it  must  take 
them,  and  it  is  safer  that  it  should. 

But  why  must  other  children  have  measles?  And 
if  they  have,  why  must  yours  have  them  too? 

If  you  believed  in  and  observed  the  laws  for  pre- 
serving the  health  of  houses,  which  inculcate  clean- 
liness, ventilation,  whitewashing,  and  other  means, 
and  which,  by  the  way,  are  laws,  as  implicitly  as  you 
believe  in  the  popular  opinion — ^for  it  is  nothing  more 
than  an  opinion — that  your  child  must  have  child- 
ren's epidemics,  don't  you  think  that  upon  the  whole 
your  child  would  be  more  likely  to  escape  altogether? 

All  the  results  of  good  nursing,  as  detailed  in  these 
notes,  may  be  spoiled  or  utterly  negatived  by  one 
defect,  viz.,  in  petty  management,  or  in  other  words, 
by  not  knowing  how  to  manage  that  what  you  do 
when  you  are  there  shall  be  done  when  you  are  not 
there.  The  most  devoted  friend  or  nurse  cannot  be 
always  there.  Nor  is  it  desirable  that  she  should.  .  .  . 
It  is  as  impossible  in  a  book  to  teach  a  person  in  charge 
of  sick  how  to  manage  as  it  is  to  teach  her  how  to 
nurse.  Circumstances  must  vary  with  each  different 
case.  But  it  is  possible  to  press  upon  her  to  think 
for  herself.  ...  To  be  "in  charge"  is  certainly  not 


2i6  A  History  of  Nursing 

only  to  carry  out  the  proper  measures  yourself  but 
to  see  that  every  one  else  does  so  too:  to  see  that  no 
one,  either  wilfully  or  ignorantly,  thwarts  or  prevents 
such  measures.  It  is  neither  to  do  everything  your- 
self nor  to  appoint  a  number  of  people  to  each  duty, 
but  to  ensure  that  each  does  that  duty  to  which  he  is 
appointed.  This  is  the  meaning  which  must  be  at- 
tached to  the  word  by  (above  all)  those  "in  charge" 
of  sick,  whether  of  numbers  or  of  individuals.   .   .   . 

Never  to  allow  a  patient  to  be  waked,  intentionally 
or  accidentally,  is  a  sine  qua  non  of  all  good  nursing. 
If  he  is  roused  out  of  his  first  sleep,  he  is  almost  certain 
to  have  no  more  sleep.  It  is  a  curious  but  quite  intel- 
ligible fact  that,  if  a  patient  is  waked  after  a  few  hours' 
instead  of  a  few  minutes'  sleeep,  he  is  much  more 
likely  to  sleep  again. 

Unnecessary  noise,  then,  is  the  most  cruel  absence 
of  care  which  can  be  inflicted  either  on  sick  or  well. 
For,  in  all  these  remarks,  the  sick  are  mentioned  as 
suffering  in  a  greater  proportion  than  the  well  from 
precisely  the  same  causes. 

All  hurry  or  bustle  is  peculiarly  painful  to  the  sick. 
And  when  a  patient  has  compulsory  occupations  to 
engage  him,  instead  of  having  simply  to  amuse  him- 
self, it  becomes  doubly  injurious.  The  friend  who 
remains  standing  and  fidgeting  about  while  a  patient 
is  talking  business  to  him,  or  the  one  who  sits  and 
poses,  the  one  from  an  idea  of  not  letting  the  patient 
talk,  the  other  from  an  idea  of  amusing  him,  each  is 
equally  inconsiderate.  Always  sit  down  when  a  sick 
person  is  talking  business  to  you,  show  no  signs  of 


Miss  Nightingale's  Writings       217 

hurry,  give  complete  attention,  and  full  consideration, 
if  your  advice  is  wanted,  and  go  away  the  moment  the 
subject  is  ended. 

Always  sit  within  the  patient 's  view,  so  that  when 
you  speak  to  him  he  has  not  painfully  to  turn  his 
head  round  in  order  to  look  at  you.  Everybody  in- 
voluntarily looks  at  the  person  speaking.  If  you  make 
this  act  a  wearisome  one  on  the  part  of  the  patient  you 
are  doing  him  harm.  So  also  if  by  continuing  to 
stand  you  make  him  continuously  raise  his  eyes  to  see 
you.  Be  as  motionless  as  possible,  and  never  gestic- 
ulate in  speaking  to  the  sick.   .   .   . 

These  things  are  not  fancy.  If  we  consider  that, 
with  sick  as  with  well,  every  thought  decomposes  some 
nervous  matter,  that  decomposition  as  well  as  re- 
composition  of  nervous  matter  is  always  going  on, 
and  more  quickly  with  the  sick  than  with  the  well ; — 
that  to  obtrude  abruptly  another  thought  upon  the 
brain  while  it  is  in  the  act  of  destroying  nervous  matter 
by  thinking  is  calling  upon  it  to  make  a  new  exer- 
tion,— if  we  consider  these  things,  which  are  facts, 
not  fancies,  we  shall  remember  that  we  are  doing  pos- 
itive injury  by  interrupting,  by  "startling  a  fanciful" 
person,  as  it  is  called.     Alas!     It  is  no  fancy.  .  .  . 

One  hint  I  would  give  to  all  who  attend  or  visit  the 
sick,  to  all  w^ho  have  to  pronounce  an  opinion  upon 
sickness,  or  its  progress.  Come  back  and  look  at  your 
patient  after  he  has  had  an  hour's  animated  conversa- 
tion with  you.  It  is  the  best  test  of  his  real  state  we 
know.  But  never  pronounce  upon  him  from  merely 
seeing  what  he  does,  or  how  he  looks  during  such  a 
conversation.   .   .   . 

Irresolution  is  what  all  patients  most  dread.  Rather 
than  meet  this  in  others,  they  will  collect  all  their  data, 


2i8  A  History  of  Nursing 

and  make  up  their  minds  for  themselves.  A  change 
of  mind  in  others,  whether  it  is  regarding  an  operation, 
or  rewriting  a  letter,  always  injures  the  patient  more 
than  the  being  called  upon  to  make  up  his  mind  to  the 
most  dreaded  or  difficult  decision. 

With  regard  to  the  reading  aloud  in  the  sick-room 
my  experience  is  that  when  the  sick  are  too  ill  to  read 
themselves  they  can  seldom  bear  to  be  read  to.  .  .  . 

The  extraordinary  habit  of  reading  to  oneself  in  a 
sick-room  and  reading  aloud  to  the  patient  any  bits 
which  will  amuse  him,  or  more  often  the  reader,  is 
unaccountably  thoughtless.  What  do  you  think  the 
patient  is  thinking  of  during  your  gaps  of  non-reading? 
Do  you  think  that  he  amuses  himself  upon  what  you 
have  read  for  precisely  the  time  it  pleases  you  to  go 
on  reading  to  yourself,  and  that  his  attention  is  ready 
for  something  else  at  precisely  the  time  it  pleases  you 
to  begin  reading  again?  .   .   . 

.  .  .  Volumes  are  now  written  and  spoken  upon 
the  effect  of  the  mind  on  the  body.  Much  of  it  is 
true.  But  I  wish  a  little  more  was  thought  of  the 
effect  of  the  body  on  the  mind.   ... 

...  I  think  it  is  a  very  common  error  among  the 
well  to  think  that  "with  a  little  more  self-con- 
trol" the  sick  might,  if  they  chose,  "dismiss  painful 
thoughts,"  which  "aggravate  their  disease,"  etc.  Be- 
lieve me,  almost  any  sick  person,  who  behaves  de- 
cently well,  exercises  more  self-control  every  moment 
of  his  day  than  you  will  ever  know  till  you  are  sick 
yourself.  Almost  every  step  that  crosses  his  room 
is  painful  to  him;  almost  every  thought  that  passes 
his  brain  is  painful  to  him ;  and  if  he  can  speak  with- 
out being  savage,  and  look  without  being  unpleasant, 
he  is  exercising  self-control.  .  .  . 


Miss  Nightingale's  Writings       219 

How  little  the  real  sufferings  of  illness  are  known 
or  understood!  How  little  does  any  one  in  good 
health  fancy  him-  or  even  herself  into  the  life  of  a  sick 
person ! 

Do,  you  who  are  about  the  sick,  or  visit  the  sick, 
try  and  give  them  pleasure,  remember  to  tell  them 
what  will  do  so.  How  often  in  such  visits  the  sick 
person  has  to  do  the  whole  conversation,  exerting  his 
own  imagination  and  memory,  while  you  would  take 
the  visitor,  absorbed  in  his  own  anxieties,  making  no 
effort  of  memory  or  imagination,  for  the  sick  person ! 

.  .  .  "What  can't  be  cured  must  be  endured"  is 
the  very  worst  and  most  dangerous  maxim  for  a  nurse 
which  ever  was  made.  Patience  and  resignation  in 
her  are  but  other  words  for  carelessness  or  indiffer- 
ence— contemptible  if  in  regard  to  herself,  culpable 
if  in  regard  to  her  sick. 

The  most  important  practical  lesson  that  can  be 
given  to  nurses  is  to  teach  them  what  to  observe,  how 
to  observe,  what  symptoms  indicate  improvement, 
what  the  reverse,  which  are  of  importance,  which  are 
the  evidence  of  neglect,  and  of  what  kind  of  neglect. 

All  this  is  what  ought  to  make  part,  and  an  essen- 
tial part,  of  the  training  of  every  nurse.  At  present 
how  few  there  are,  either  professional  or  unprofes- 
sional, who  really  know  at  all  whether  any  sick  person 
they  may  be  with  is  better  or  worse.  ...  It  is  a 
much  more  difficult  thing  to  speak  the  truth  than  peo- 
ple commonly  imagine.  There  is  the  want  of  obser- 
vation simple,  and  the  want  of  observation  compound, 
compounded,  that  is,  with  the  imaginative  faculty. 
The  information  of  the  first  is  simply  defective.  That 
of  the  second  is  much  more  dangerous.  The  first  gives, 
in  answer  to  a  question  asked  about    a  thing  that 


2  20  A  History  of  Nursing 

has  been  before  his  eyes  perhaps  for  years,  informa- 
tion exceedingly  imperfect,  or  says  he  does  not  know. 
He  has  never  observed.  And  people  simply  think 
him   stupid. 

The  second  has  observed  just  a  little,  but  imagina- 
tion immediately  steps  in,  and  he  describes  the  whole 
thing  from  imagination  merely,  being  perfectly  con- 
vinced all  the  while  that  he  has  seen  or  heard  it;  or 
he  will  repeat  a  whole  conversation  as  if  it  were  infor- 
mation which  had  been  addressed  to  him:  whereas 
it  is  merely  what  he  has  himself  said  to  somebody  else. 
This  is  the  commonest  of  all.  These  people  do  not 
ev^en  observe  that  they  have  not  observed,  nor  re- 
member that  they  have  forgotten. 

Courts  of  justice  seem  to  think  that  anybody  can 
speak  "the  whole  truth,  and  nothing  but  the  truth," 
if  he  does  but  intend  it.  It  requires  many  faculties 
combined  of  observation  and  memory  to  speak 
"the  whole  truth,"  and  to  say  "nothing  but  the 
truth." 

In  dwelling  upon  the  vital  importance  of  sound  ob- 
servation, it  must  never  be  lost  sight  of  what  observa- 
tion is  for.  It  is  not  for  the  sake  of  piling  up  miscel- 
laneous information  or  curious  facts,  but  for  the  sake 
of  saving  life  and  increasing  health  and  comfort. 
The  caution  may  seem  useless,  but  it  is  quite  surprising 
how  many  men  (some  women  do  it  too)  practically 
behave  as  if  the  scientific  end  were  the  only  one  in 
view,  or  as  if  the  sick  body  were  but  a  reservoir  for 
stowing  medicines  into,  and  the  surgical  disease  only 
a  curious  case  the  sufferer  has  made  for  the  attend- 
ant's   special    information.  .  .   . 

For  it  may  safely  be  said,  not  that  the  habit  of 
ready  and  correct  observation  will  by  itself  make  us 


Miss  Nightingale's  Writings       221 

useful  nurses,  but  that  without  it  we  shall  be  useless 
with  all  our  devotion. 

It  seems  a  commonly  conceived  idea  among  men 
and  even  among  women  themselves  that  it  requires 
nothing  but  a  disappointment  in  love,  the  want  of 
an  object,  a  general  disgust  or  incapacity  for  other 
things,  to  turn  a  woman  into  a  good  nurse. 

This  reminds  one  of  the  parish  where  a  stupid  old 
man  was  set  to  be  a  schoolmaster  because  he  was 
"past  keeping  the  pigs." 

Apply  the  above  receipt  for  making  a  good  nurse 
to  making  a  good  servant;  and  the  receipt  will  be 
found  to  fail. 

.  .  .  The  everyday  management  of  a  large  ward,  let 
alone  of  a  hospital,  the  knowing  what  are  the  laws  of 
life  and  death  for  men,  and  what  the  laws  of 
health  for  wards  (and  wards  are  healthy  or  unhealthy 
mainly  according  to  the  knowledge  or  ignorance  of 
the  nurse) ,  are  not  these  matters  of  sufficient  import- 
ance and  difficulty  to  require  learning  by  experience 
and  careful  inquiry,  just  as  much  as  any  other  art?  ^ 

Notes  on  Nursing  for  the  Labouring  Classes  is, 
in  some  respects,  the  most  noteworthy  of  the  re- 
visions of  Notes  on  Nursing.  It  incorporates  the 
most  vital  portions  of  the  latter  work  and  con- 
tains an  inspiring  and  most  practical  chapter  on 
*'  The  Health  of  the  House,"  with  special  reference 
to  and  detail  for  rural  cottages. 2     It  sounds,  more- 

»  Extracts  from  Notes  on  Nursing,  i860.  By  permission  of 
D.  Appleton  &  Co.,  New  York. 

2  The  Rural  Housing  and  Sanitation  Association,  with 
offices  at  9  Southampton  St.,  Holborn,  W.  C,  London,  is 
carrying  on  this  work  to-day,  but  even  yet  conditions  are 
painfully  the  same  as  when  the  Notes  was  written. 


222  A  History  of  Nursing 

over,  an  ardent  plea  for  the  better  housing  of 
workers,  and  expresses  her  deep  pity  and  distress 
over  bad  factory  conditions  and  the  disasters  oi^ 
sweated  home  industries : 

How  much  sickness,  misery,  and  death  are  pro- 
duced by  the  present  state  of  many  factories,  ware- 
houses, workshops,  and  workrooms!  The  places 
where  poor  dressmakers,  tailors,  letter-press  printers, 
and  other  similar  trades  have  to  work  for  their  living 
are  generally  in  a  worse  condition  than  any  other  por- 
tions of  our  worst  towns.  Many  of  these  places  of 
work  were  never  constructed  for  such  an  object.  They 
are  badly  adapted  garrets,  sitting-rooms,  or  bed- 
rooms, generally  of  an  inferior  class  of  houses.  No 
attention  is  paid  to  the  cubic  space  or  ventilation. 
The  poor  workers  are  crowded  on  the  floor  to  a  greater 
extent  than  occurs  with  any  other  kind  of  overcrowd- 
ing. ...  In  such  places,  and  under  such  circum- 
stances of  constrained  posture,  want  of  exercise, 
hurried  and  insufficient  meals,  long  and  exhaustive  la- 
bour, and  foul  air.  ...  is  it  wonderful  that  a  great 
majority  of  them  die  easily  of  chest  disease?  .  .  . 
Employers  seldom  consider  these  things.  Healthful 
working  rooms  are  no  part  of  the  bond  into  which 
they  enter  with  their  working  people.  They  pay 
their  money  .  .  .  and  for  this  wage  the  worker  has  to 
give  up  work,  health,  and  life.  .  .  .  Working  people 
should  remember  that  health  is  their  only  capital,  and 
should  come  to  an  understanding  among  themselves 
to  secure  pure  air  in  their  places  of  work,  which  is  one 
of  the  principal  agents  of  health.  This  would  be 
worth  a  "trades- union,"  almost  worth  a  "strike." 
.  .  .  If  tenants  would   be   so  wise   as  to  refuse  to 


Miss  Nightingale's  Writings        223 

occupy  unhealthily  built  homes,  builders  would  soon 
be  brought  to  their  senses.  .  .  . 

Presently,  with  her  own  inimitable  irony,  she 
throws  this  remark  in  a  footnote : 

This  very  year,  1868,  a  health  report  has  appeared 
in  Manchester  which  is  virtually  to  this  effect:  Let 
the  town  breed  as  much  infectious  disease  as  it  Hkes; 
put  the  cases  into  big  infirmaries:  this  is  the  way  to 
cure  Manchester — to  build  hospitals  to  cure  people 
after  they  have  been  killed. 

This  edition  also  contains  a  chapter  on  "  Mind- 
ing Baby,"  the  sweetest,  brightest,  intimate  and 
simple  talk  to  girls  imaginable. 

And  now,  girls,  I  have  a  word  for  you.  You  and 
I  have  all  had  a  great  deal  to  do  in  minding  baby, 
though  "baby"  was  not  our  own  "baby." 

Thus  she  begins,  and  goes  on  to  a  talk  on  the 
health  and  care  of  infants  that  is  a  perfect  model 
of  important  truths  and  simple  style.  Few  are 
the  words  over  one  syllable,  and  yet  the  most 
thorough  scientist  might  willingly  own  its  author- 
ship. The  entire  book  is  sanitary  teaching  in  its 
most  convincing  and  persuasive  form. 

Of  her  Notes  on  Hospitals,  it  has  been  said 
that  it  has  "probably  done  more  than  any  other 
treatise  to  promote  sound  views  of  hospital 
economy."^ 

This,  as  well  as  two  notable  papers  on  India, 

1  Tent  Hospitals,  by  J.  Foster  Jenkins.  Amer.  Soc.  Sci, 
Journ.,  May,  21,  1874. 


224  A  History  of  Nursing 

were  first  read  at  the  meetings  of  the  English  Na- 
tional Association  for  the  Promotion  of  Social 
Science,  afterwards  being  reprinted  in  book  form, 
and  it  has  been  said  that  they  are  the  most  able 
papers  ever  presented  to  that  association. 

Miss  Nightingale's  genius  was  early  recognised 
by  Sidney  Herbert,  and  utilised  by  him  in  the 
work  of  army  reorganisation.  Though  now  the 
least  known  of  her  writings,  her  various  mono- 
graphs on  the  army  had  in  their  day  an  immense 
influence,  and  show  most  strikingly  her  remark- 
able mental  grasp  and  generalship.  This  is  par- 
ticularly true  of  her  Notes  on  Matters  affecting 
the  Health,  Efficiency,  and  Hospital  Administra- 
tion of  the  British  Army,  presented  by  request 
to  the  Secretary  of  State  for  War,  and  published 
in  1858.  This  (a  work  of  considerable  size)  takes 
up  the  entire  field  of  army  organisation  from  every 
aspect  except  that  which  is  purely  military,  and 
discusses,  first,  the  entire  official  correspondence 
and  the  records  of  the  whole  Crimean  campaign, 
pointing  out  in  minutest  detail  every  defect  in 
organisation  of  the  commissariat,  the  purveying, 
the  medical  departments,  dieting  and  cooking, 
transport,  statistics,  regimental  and  general  hos- 
pitals, sanitary  (or  unsanitary)  conditions,  laundry, 
canteens,  and  conditions  of  the  soldier's  social 
and  family  relations. 

Every  criticism  is  accompanied  by  a  construct- 
tive  recommendation.  Every  riddling  of  clumsy 
inadequacy  is  followed  by  a  picture  of  a  practical 


Miss  Nightingale's  Writings       225 

and  efficient  working  method.  Every  exposure 
of  stupidity  is  linked  with  a  corresponding  plan 
for  attaining  clear  sanitary  benefits. 

Miss  Nightingale's  brilliant  perception  even  re- 
constructed the  whole  medical  hierarchy;  she  dis- 
cusses the  pay  and  promotion  of  medical  officers, 
medical  education,  sanitary  officers  for  hospitals 
and  encampments;  gives  actual  and  proposed 
forms  for  medical  statistics  in  the  army,  and 
shows  the  importance  of  a  scientific  study  of  the 
diseases  incident  to  army  life. 

All  that  the  Japanese  have  recently  so  brilliantly 
demonstrated  could  be  done,  to  reduce  the  death 
rate  from  preventible  causes  to  a  minimum,  she 
here  and  elsewhere  besought  the  English  govern- 
ment to  do. 

It  is  not  denied  that  a  large  part  of  the  British  force 
perished  from  causes  not  the  unavoidable  or  necessary 
results  of  war.  .  .  .  (10,053  men,  or  sixty  per  cent, 
per  annum,  perished  in  seven  months,  from  disease 
alone,  upon  an  average  strength  of  28,939.  This  mor- 
tality exceeds  that  of  the  Great  Plague)  ....  The 
question  arises,  must  what  has  here  occurred  occur 
again  ? 

No  tribunal  has  ever  yet  tried  this  question.  It 
hardly  seems  to  have  occurred  to  the  national  mind. 

.  .  .  Immediately  after  the  troops  went  to  the 
East,  the  practical  inefficiency  of  the  Army  Medical 
Department  began  to  shew  itself. 

Abstracts  of  correspondence  follow,  showing 
failures     to    adopt     recommendations    made    in 

VOL.  n.—  '■.5 


226  A  History  of  Nursing 

advance  by  a  commission  in  charge  of  the  health 

of  the  army. 

It  would,  indeed,  be  difficult  to  frame  a  system  of 
adrndnistration  more  likely  to  lose  an  army  at  any 
time  than  this.  Here  is  the  first  downward  step  of 
our  noble  army  to  destruction. 

Abstracts  of  records  follow  showing  the  failure 
to  supply  proper  rations  to  the  army  in  the  field, 
absence  of  vegetables,  and  appearance  of  scurfy. 

The  great  calamity  is  now  drawing  to  its  height. 
.  .  .  Had  half  the  ingenuity  exercised  in  sending 
out  lime  juice  been  expended  in  making  that  article 
unnecessary,  the  army  might  have  returned  to  England 
alive  and  well.  From  this  point,  the  correspond- 
ence seems  to  read  as  if  the  medical  office  was  to  regis- 
ter post-mortem  appearances,  instead  of  keeping  the 
patient  in  health — as  if  the  business  of  the  police  was 
to  record  murders  instead  of  preventing  them. 

In  order  to  make  this  intelligible,  it  is  necessary  to 
give  a  short  summary  of  what  the  army  did  receive  in 
vegetables  and  blankets.   ... 

The  summaries  follow,  all  calamitous  facts. 

.  .  .  For  three  months  this  army  had  not  had 
the  means  of  cleanliness  (no  soap)  either  as  to  their 
persons  or  clothing:  and  what  the  state  of  the  men 
was,  on  arriving  at  Scutari,  let  those  who  saw  it 
testify.  .  .  . 

Abstracts  of  letters  between  Drs.  Smith  and 
Hall  follow^  saying  "symptoms  of  scurvy"  are 
appearing  among  the  men. 


Miss  Nightingale's  Writings       227 

The  expression  "symptoms  of  scurvy"  seems  quite 
inexplicable,  as  well  as  that  of  its  "not  having  made 
much  progress."  The  army  was  dying,  and  of  scurvy. 
More  than  half  the  infantry  was  sick  in  hospital  during 
this  month  (January,  1855).  .  .  .  Yet  there  is  noth- 
ing in  these  letters  to  indicate  that  either  Principal 
Medical  Officer  or  Director- General  know  that  an  army 
is  dying,  or  that,  if  it  is,  it  is  any  business  of  theirs. 
January  24,  Dr.  Smith  objects  to  the  issue  of  un- 
ground  coffee  (the  troops  had,  for  four  months,  had 
only  green  coffee  beans  issued  to  them).  .  .   . 

Now,  also,  arrived  the  lime  juice  so  painstak- 
ingly sent,  Dr.  Hall  having  received  all  the  notifi- 
cations, but  six  weeks  after  its  arrival  it  had  not 
been  given  out.  The  winter  having  passed,  com- 
missions were  appointed. 

One  would  think  that  the  fact,  well  known  by  this 
time,  of  an  army  having  all  but  perished  would  have 
been  of  itself  a  sufficient  reason  for  the  severest  ani- 
madversion from  the  head  of  the  army  medical  depart- 
ment. But  no.  The  Sebastopol  Committee  is  to 
have  the  doings  of  that  department  before  it,  and  Dr. 
Smith  writes  to  his  principal  medical  officer  : 

"I  beg  you  to  supply  me,  and  that  immediately  " — 
with  what? — "with  every  kind  of  information  which 
you  may  deem  likely  to  enable  me  to  establish  a  char- 
acter for  it"  (the  department),  "which  the  pubHc 
appears  desirous  to  prove  that  it  does  not  possess." 
What  hope  for  the  army  after  this?  He  might  as  well 
have  said,  Never  mind  anything  if  you  only  enable  me 
to  free  the  department  from  blame.  .  .  . 

Analyses  of  lists  of  medical  supplies,  and  light 


228  A  History  of  Nursing 

diets,  etc.,  called  "medical  comforts,"  are  then 
made  and  compared  with  the  numbers  of  the  sick, 
showing  glaring  insufficiency. 

On  Jan.  i,  1855,  the  number  of  patients  who  had 
arrived  in  the  hospitals  of  the  Bosphorus  during  the 
last  fortnight  amounting  to  2532,  followed  by  1044 
more  in  the  next  six  days,  the  superintendent  of 
nurses,  according  to  her  invariable  custom  of  ascer- 
taining first  whether  the  articles  for  which  requisition 
was  made  upon  her  by  medical  officers  were  or  were 
not  in  the  purveyor's  stores,  in  order  that  no  ostenta- 
tious display  or  imnecessary  issue  might  be  made  by 
her,  received  the  following  return — 

in  brief,  of  plates,  candlesticks,  tin  drinking  cups, 
pails  for  tea,  bolsters,  slippers,  knives,  forks, 
spoons,  flannel  shirts,  socks,  and  drawers,  there 
were  none;  of  bedpans,  some;  and  of  night-caps, 
a  few. 

Let  it  not  be  said,  "  It  is  all  past,  let  bygones  be  by- 
gones." A  future  war  is  not  past.  We  are  speaking 
for  the  future.  Otherwise  it  may  be  prophesied  .  .  . 
that,  exactly  in  the  proportion  in  which  similar  cir- 
cumstances recur,  will  similar  destruction  recur.  We 
shall  do  as  before  and  lose  again  half  an  army  from 
disease.   .  .  . 

Methods  of  sanitar}^  administration  are  then 
discussed  fully. 

If  you  treat  your  Director-General  like  a  schoolboy 
you  will  have  a  schoolboy  for  your  Director-General. 

The  mischief  to  the  public  service  is  produced  in 
this  way:    Scientific  men  are  placed  in  a  position  re- 


Miss  Nightingale's  Writings       229 

quiring  them  to  give  advice  whether  they  be  asked  for 
it  or  not.  Other  considerations  not  htown  to  their  de- 
partment are  then  acted  upon.  This  is  a  certain  way 
of  destroying  the  sense  of  responsibiHty.  .  .  .  The 
consequence  will  be  that  there  will  be  no  scientific 
men  in  the  department. 

Recommendations  for  an  ideal  sanitary  service 
then  follow,  practically  covering  every  detail 
which  the  Japanese  have  since  then  put  into 
practice. 

As  to  laundry  matters,  Miss  Nightingale  states 
that  in  the  Barrack  hospital  the  number  of  towels 
washed  by  the  purveyor  during  November,  De- 
cember, and  January,  with  from  2000  to  2400 
patients  in  the  wards,  was  132  towels.  The  amia- 
ble Mr.  Wreford  wrote  in  February,  ''The  neces- 
sity for  a  subsidiary  washing  establishment  has 
never  been  made  apparent  to  me."  .  .  . 

As  to  the  lack  of  hospital  comforts.  Miss  Night- 
ingale says,  ''This  has  been  denied,  will  be  denied 
again ;  a  few  official  records  are  therefore  annexed. " 

Of  the  nursing  service  Miss  Nightingale  says 
here: 

If,  with  a  party  of  female  volunteers  so  suddenly 
formed,  .  .  .  the  labours  of  female  nurses  could  be 
carried  on  for  nearly  two  years  advantageously  (as  it 
is  presumed)  to  the  soldier,  and  without  injurious  dis- 
turbance to  the  medical  and  military  departments  of 
hospital  government,  it  must  necessarily  be  admitted 
that  the  female  nursing  element  may  be  introduced 
into  military  hospitals  in  future,  concurrently  with  a 


230  A  History  of  Nursing 

better  system  of  orderlies:  the  number  of  nurses  being 
restricted  and  the  duties  better  defined.  It  must  be 
added  that  it  is  absolutely  necessary  that  the  high 
character  and  respectability  of  the  female  must  be 
maintained,  both  as  to  her  personal  and  official  con- 
duct; and  no  motives  of  supposed  utility  should  be 
allowed  to  require  or  lead  her  to  do  that  which  would 
lower  her  morally  or  officially 

^liss  Nightingale  notes  the  fact,  obsen^ed  by 
other  nurses  later,  that  discipline  in  military  hos- 
pitals does  not  approach  that  of  civil  institutions. 
Of  special  interest  also,  of  her  writings  on  the 
army,  is  her  "  Army  Sanitary  Administration  and 
its  Reform  under  the  late  Lord  Herbert,"  ^  for  in 
this  she  sets  forth  in  order  all  the  different  branches 
of  reform  which  we  know  (though  she  does  not 
say  so)  were  in  reality  the  outcome  of  her  practical 
and  suggestive  reports  made  to  him  privately. 
She  says : 

...  In  times  past,  war  has  been  conducted  in 
more  or  less  forgetfulness,  sometimes  in  total  oblivion, 
of  the  fact  that  the  soldier  is  a  mortal  man,  subject  to 
all  the  ills  following  on  wet  and  cold,  want  of  shelter, 
bad  food,  excessive  fatigue,  bad  water,  intemperate 
habits,  and  foul  air.  .  .  .  And  who  can  tell  how 
much  systematic  attempts  made  by  all  nations  to 
diminish  the  horrors  of  that  great  curse,  war,  may  not 
lead  the  way  to  its  total  disappearance  from  the  earth? 
The  faithful  records  of  all  wars  are  records  of  prevent- 
ible  suffering,  disease  and  death.     It  is  needless  to 

»  Read  at  the  London  meeting  of  the  Congrks  de  Bienfais* 
ance,  June,  1862. 


Miss  Nightingale's  Writings       231 

illustrate  this  truth,  for  we  all  know  it.  But  it  is  only 
from  our  latest  sorrow,  the  Crimean  catastrophe,  that 
dates  the  rise  of  army  sanitary  administration  in  this 
country.  ...  No  provision  was  made  for  the  systematic 
care  of  the  soldier's  health,  but  only  for  his  sickness. 
...  In  all  our  wars,  our  general  hospitals  have 
been  signal  failures,  fatal  examples  of  how  to  kill,  not 
to  cure. 

She  calls  Herbert  ''  highest  among  the  savers  of 
men,"  and  says  of  him: 

Sidney  Herbert,  although  his  passion,  his  heredit- 
ary occupation  to  which  he  was  born  and  bred  was 
politics,  yet  made  his  administrative  labours  greater, 
set  his  administrative  objects  higher,  recoiled  from 
none  of  its  dry  fatigue,  and  attained  its  highest 
usefulness. 


He  did  not  sink  in  politics  the  powers  which  were 
meant  for  mankind.  .  .  .  The  first  war  minister  who 
seriously  set  himself  to  the  task  of  saving  life.  .  .  . 
Let  us  hope  that  the  great  lesson  which  has  been 
taught  will  have  its  weight  with  those  charged  with 
the  duty  of  protecting  the  public  health. 

The  Sanitary  State  of  the  Army  in  India  ^  is 
likewise  written  in  her  most  masterly,  lucid,  and 
trenchant  style.  Her  comments  on  the  details 
of  the  report,  her  summary  of  the  whole,  and  her 
indictment  of  the  conditions  and  systems  allowed 
to  exist  are  scathing  and  unsparing. 

»  Being  observations  on  the  evidence  contained  in  the 
statistical  report  submitted  to  her  by  the  Royal  Commission. 


232  A  History  of  Nursing 

Native  caste  prejudice  [she  observes]  appears  to 
have  been  made  the  excuse  for  European  laziness  as 
far  as  regards  our  sanitary  and  hospital  neglects  of  the 
native." 

With  an  unswen^ing  hand  she  dissects  the  feeble 
and  futile  attempts  of  governments  to  regulate 
vice  and  drink.  "Common-sense  is  the  same  as 
moral  sense  in  these  things,  "  she  concludes. 

In  her  article  on  Village  Sanitation  in  India  ^ 
her  inexhaustible  human  sympathies  are  shown 
again  in  her  reference  to  the  ancient  customs  of 
the  vanished  Hindoo  civilisation.  This  cathoHc 
sympathy  was  the  mainspring  of  her  energy. 

Under  the  old  village  organisation  [she  said]  the 
villagers,  working  under  their  head  man,  managed,  in 
their  humble  way,  every  department  of  business  re- 
quired for  their  local  wants,  and  it  was  the  duty  of 
certain  low  caste  village  servants  to  remove  dead  ani- 
mals and  perform  other  sanitary  work.  But,  unfor- 
tunately, in  a  large  part  of  India  the  village  system 
has  been  allowed  to  fall  into  decay.  The  ancient 
patriarchal  methods  have  ceased  to  be  effectual,  while 
as  yet  little  has  been  done  to  find  any  modern  substi- 
tute.    The  results  are  very  deplorable. 

She  then  quotes  from  the  report  of  a  sanitary 
commission,  and  says  she  had  had  the  advantage 
of  corresponding  with  these  commissions  and  with 
educated  Indian  gentlemen  who  were  interested 

iRead  before  the  Tropical  Section  of  the  i8th  International 
Congress  of  Hygiene  and  Demography,  Buda-Pesth,  Septem- 
ber, 1894. 


Miss  Nightingale's  Writings       233 

in  this  subject,  adding  that  it  was  clear  the  chief 
improvements  needed  were  a  diminution  of  over- 
crowding, the  carrying  away  of  sewage,  and  a 
better  water  supply,  and  continues : 

As  regards  removal  of  sewage  and  care  of  water- 
supply,  much  may  be  done  by  the  villagers  themselves 
if  they  can  be  made  to  understand  the  terrible  result 
of  neglect  and  the  benefits  of  the  most  simple  remedies. 
I  have  therefore  appealed  to  my  educated  Indian 
friends  to  instruct  their  poorer  brethren  in  these  vital 
truths.  And  I  have  ventured  to  suggest  to  them  that 
health  missioners  might  be  sent  among  the  villagers, 
men  (and  women  also,  to  convert  the  rural  mothers, 
whose  influence  in  this  matter  is  great  and  whose  dear- 
est interests  are  at  stake)  well  versed  in  the  principles 
of  sanitation  and  at  the  same  time  sympathetic  and 
conciliatory.  Lectures  and  practical  demonstrations 
might  be  given  out  in  the  village  school-rooms.  But 
the  lectures  would  only  be  the  first  beginning  of  the 
teaching :  a  lecturer  who  had  made  himself  acceptable 
to  the  people,  would  go  around  the  village  and  show 
the  people  how  to  dispose  of  their  refuse:  he  would 
explain  to  them  the  dangers  of  depositing  it  in 
their  little  close  courtyards.   .   .  . 

Then  he  would  go  with  them  and  examine  their 
water-supply,  and  show  them  certain  simple  precau- 
tions to  be  observed.  .  .  .  The  Hindoo  religion 
enjoins  so  much  purity  and  cleanliness  that  the  influ- 
ence of  religious  teachers  and  of  all  caste  Panchayats 
(or  councils)  might  be  usefully  appealed  to.  With  a 
gentle  and  affectionate  people  like  the  Hindoos  much 
may  be  accomplished  by  personal  influence.  .  .  .  The 
government    is    powerful  .  .  ,  but  in    such    delicate 


234  A  History  of  Nursing 

matters,  affecting  the  homes  and  customs  of  a  very 
conservative  people,  almost  more  may  be  done  by  per- 
sonal influence,  exercised  with  kindly  sympathy  and 
respect  for  the  prejudices  of  others.  .   .  . 

On  the  same  lines,  and  overflowing  with  care 
for,  and  eager  interest  in,  the  homes  of  the  people, 
was  her  paper  on  "Rural  Hygiene."^  She  refers 
therein  to  the  woman  health  missioners  who  were 
hoped  for  in  India,  and  exclaims : 

Let  not  England  lag  behind,  especially  in  the  con- 
viction that  nothing  can  be  done  without  personal 
friendship  with  the  women  to  be  taught.  It  is  a  truism 
to  say  that  the  women  who  teach  in  India  must  know 
the  language,  the  religious  superstitions  and  customs 
of  the  women  to  be  taught  in  India.  It  ought  to  be 
a  truism  to  say  the  same  for  England.  We  must  not 
talk  to  them,  or  at  them,  but  with  them.   .  .  . 

.  .  .  What  is  the  existing  machinery  of  public 
health  in  what  are  called,  with  a  grim  sarcasm,  our 
rural  sanitary  districts?  Is  health  or  sickness,  life  or 
death,  the  greatest  miracle  in  the  present  condition  of 
things?  To  some  of  us  the  greatest  miracle,  repeated 
every  day,  is  that  we  can  live  at  all  in  the  surround- 
ings which  our  ignorance  and  neglect  create. 

After  reviewing  the  conditions,  legislation,  and 
its  difficulties,  she  says : 

These  are  the  facts  as  they  are.  Now  let  us  con- 
sider what  they  ought  to  be. 

We  want  independent  medical  officers  of  health, 

1  Presented  at  the  Conference  of  Women  Workers,  Leeds, 
November,  1893. 


Miss  Nightingale's  Writings       235 

appointed  by  the  county  council,  and  removable  only 
by  them — men  trained  for  this  as  a  profession;  we 
want  sanitary  inspectors  with  a  proper  qualification, 
appointed  with  the  medical  officer's  approval;  we 
want  that  each  medical  officer  should  be  informed  as 
to  all  approaches  of  dangerous  disease,  and  bound  in 
his  term  to  supply  the  information  for  other  neigh- 
bouring districts :  we  want  sanitary  inspectors  who  are 
duly  qualified  by  examination  acting  under  the  direc- 
tions of  medical  officers,  in  order  that  they  may  feel 
themselves  responsible  for  their  appointment,  and 
co-operators  in  their  work,  sanitary  inspectors  who 
are  not  removable  unless  for  neglect  of  duty,  and  cer- 
tain to  be  removed  if  they  do  persistently  neglect  it 
We  want  a  fully  trained  nurse  for  every  district,  and 
a  health  missioner:  we  want  a  water-supply  to  each 
village,  rain-water  properly  stored;  earth  closets; 
scavenging — as  necessary  a  public  duty  as  paving  and 
lighting:  gardens  near  houses,  and  allotments  where 
refuse  and  privy  contents  are  used;  .  .  .  cottage 
owners  made  amenable  to  sanitary  laws,  compelling 
the  landlord  to  give  his  cottages  the  essentials  for 
health  so  far  as  construction  is  concerned;  school 
teaching  of  health  rules  made  interesting  and  clear  by 
diagrams  showing  dangers  of  foul  drains,  etc.  (But 
we  must  not  expect  too  much  practical  result  from 
this.  It  has  failed,  except  as  a  book  or  lesson,  where 
it  has  been  tried  in  India.  The  schoolmaster  himself 
should  be  a  health  apostle.) 

After  describing  in  detail  the  absence  of  a  good 
sanitary  condition  in  villages  she  scorches  and 
flays  public  apathy : 

In   these   days   of    investigations    and     statistics. 


236  A  History  of  Nursing 

where  results  are  described  with  microscopic  exactness 
and  tabtilated  with  mathematical  accuracy,  we  seem 
to  think  figures  will  do  instead  of  facts,  and  calcula- 
tion instead  of  action.  We  remember  the  policeman 
who  watched  his  burglar  enter  the  house,  and  waited 
to  make  quite  sure  whether  he  was  going  to  commit 
robbery  with  violence  or  not,  before  interfering  with 
his  operations.  So  as  we  read  such  an  account  as  this 
we  seem  to  be  watching,  not  robbery,  but  murder 
going  on,  and  to  be  waiting  for  the  rates  of  mortality 
to  go  up  before  we  interfere.  We  wait  to  see  how  many 
children  playing  around  the  houses  shall  be  stricken 
down.  We  wait  to  see  whether  the  filth  will  really 
trickle  into  the  well,  and  whether  the  foul  water  will 
really  poison  the  family  and  how  many  will  die  of  it. 
And  then,  when  enough  have  died,  we  think  it  time  to 
spend  some  money  and  some  trouble  to  stop  the  mur- 
ders going  further,  and  we  enter  the  results  of  our 
"masterly  inactivity"  neatly  in  tables,  but  we  do 
not  analyse  and  tabulate  the  saddened  lives  of  those 
who  remain,  and  the  desolate  homes  of  our  "sanitary 
districts." 

Now  let  us  come  to  what  the  women  have  to  do 
with  it,  i.  e.,  how  much  the  cottage  mothers,  if  in- 
structed by  instructed  women,  can  remedy  or  prevent 
these  and  other  frightful  evils?  .... 

Then  follows  the  best  syllabus  of  instruction  in 
domestic  sanitation  that  has  ever  been  put  to- 
gether, and  through  it  all  throbs  the  spiritualised 
maternal  instinct  which  is  hers  in  rare  fullness. 

Sympathy  with  interest  in  the  poor  so  as  to  help 


Miss  Nightingale's  Writings       237 

them  can  only  be  got  by  long  and  close  intercourse 
with  each  in  her  own  house — not  patronising — "talk- 
ing down"  to  them,  not  "prying  about."  Sympathy 
which  will  grow  in  insight  and  love  with  every  visit: 
which  will  enable  you  to  show  the  cottage  mother  on 
the  spot  how  to  give  air  to  the  bedroom,  etc.  You 
could  not  get  through  the  daily  work  of  the  cottage 
mother,  the  cooking,  washing,  cleaning,  mending, 
making.  .  .  .  And  don't  think  the  gain  is  all  on 
their  side.  How  much  we  learn  from  the  poor,  how 
much  from  our  patients  in  the  hospital,  when  heart 
meets  heart.  .  .  .  The  criticism  on  all  this  will  be: 
'  What  an  enormous  time  it  will  take.  You  are  de- 
scribing a  process  that  will  not  take  weeks,  but  months 
and  years.  Life  is  not  long  enough  for  this."  Our 
reply  is  that  for  centuries  there  have  been  super- 
stitions, for  centuries  the  habits  of  dirt  and  neglect 
have  been  steadily  and  perseveringly  learnt,  and  that, 
if  we  can  transform  by  a  few  years'  quiet,  persistent 
work  the  habits  of  centuries,  the  process  will  not  have 
been  slow,  but  amazingly  rapid.  What  is  "slow" 
in  more  senses  than  one  is  the  eternal  lecturing  that  is 
vox  et  prcBterea  nihil — words  that  go  in  one  ear  and  out 
the  other.  The  only  word  that  sticks  is  the  word  that 
follows  work.  The  work  that  "pays"  is  the  work  of 
the  skilful  hand  directed  by  the  cool  head  and  in- 
spired by  the  loving  heart.  Join  heart  with  heart, 
and  hand  with  hand,  and  pray  for  the  perfect  gift  of 
love  to  be  the  spirit  and  the  life  of  all  your  work. 

Can  there  be  any  higher  work  than  this?  Can  any 
woman  wish  for  a  more  womanly  work?  Can  any 
man  think  it  unworth}^  for  the  best  of  women  ? 

We  are  inclined  to  class  with  her  teachings  on 


238  A  History  of  Nursing 

hygiene  and  sanitation  her  work  on  Lying-in  Hos- 
pitals,  a  book  of  some  size,  characteristically  dedi- 
cated to  the  "  Shade  of  Socrates'  Mother." 

The  introduction  tells  how,  in  the  year  1862, 
the  Nightingale  committee,  with  a  view  of  extend- 
ing the  advantages  of  the  Nightingale  school,  made 
arrangements  with  the  authorities  of  St.  John's 
House  by  which  w^ards  were  fitted  up  in  the  new 
part  of  the  King's  College  hospital,  opening  out  of 
the  great  staircase  but  closed  in  behind  their  own 
doors,  for  the  reception  of  midwifery  patients. 
The  wards  and  nursing  w^ere  under  the  charge  of 
the  lady  superintendent,  and  every  precaution 
(as  it  was  thought)  was  taken  to  secure  the  well- 
being  of  the  patients.  But  the  record  of  puerperal 
sepsis  w^as  so  grave,  even  though  not  as  bad  as  in 
other  institutions,  that  the  Nightingale  committee 
decided  to  close  up  the  wards. 

Miss  Nightingale  then,  though  in  ill-health, 
gave  her  attention  to  making  a  thorough  study 
of  the  subject  and  the  conditions  under  which 
maternity  hospitals  were  conducted.  She  found 
striking  vagueness  and  inexactness  in  the  statistics 
of  many  institutions,  as  well  as  in  the  prevalent 
medical  theories  on  puerperal  sepsis.  True,  med- 
ical writers  had  not  been  lacking  to  declare  its 
communicable  character,  1   yet  others,   of  whom 

>  In  1843  Oliver  Wendell  Holmes  had  read  his  article  "The 
Contagiousness  of  Puerperal  Fever"  to  the  Medical  Society 
and  declared  that  it  could  be  carried  from  patient  to  patient 
by  physician  and  nurse.     In  this  essay  Holmes  quoted  a  long 


Miss  Nightingale's  Writings      239 

Miss  Nightingale  quotes  Le  Fort,  held  that  it  could 
originate  de  novo.  In  her  investigations  Miss 
Nightingale  found  that  the  restrictions  laid  down 
as  to  the  admission  of  students  to  the  lying-in 
wards  at  King's  College  hospital  had  been  disre- 
garded ;  also  that  a  post-mortem  theatre  had  been 
erected  almost  under  the  ward  windows.  While 
she  made  no  criticism  on  persons,  she  emphasised 
principles  strongly,  and  declared  that  those 
hospital  authorities  incurred  grave  responsibility 
who  did  not  assure  themselves  that  students  ad- 
mitted to  maternity  practice  gave  up,  for  the  time 
being,  all  connection  with  general  wards  or  with 
anatomical  schools. 

She  characterised  existing  hospital  records  and 
death-rate  statistics  as  grotesque  (except  that  the 
subject  was  so  serious),  pointing  out  that  child- 
birth was  not  a  disease  and  should  not  be  entered 
as  such,  and  that  it  was  especially  unjust  to  class 
it  as  a  ''miasmatic  disease."  She  concluded  by 
summing  up  the  evidence  and  showing  that  no 
lying-in  ward  should  be  connected  with  a  general 
hospital  service,  and  then  presented  plans  and 
schedules  for  separate  buildings  and  a  properly 
organised  separate  service  with  midwifery  teach- 
ing for  women. 

In  coming  to  the  subject  of  training  and  organ - 

list  of  distinguished  physicians  who  had  pointed  out  its  con- 
tagious character,  going  back  to  Dr.  Gordon  of  Aberdeen  in 
1795.  See  the  writings  of  OHver  Wendell  Holmes.  Houghton 
&  Mifflin,  Boston,  1891,  vol.  ix.,  p.  131  ^/  seq. 


240  A  History  of  Nursing 

ising  a  nursing  staff,  in  which  Miss  Nightingale^s 
genius  shines  so  brilliantly,  no  better  introduction 
could  be  planned  than  her  own  exposition  of  her 
studies  and  observations  of  nursing  systems  as 
they  existed  in  1862.  This  set  of  data  stands  as 
an  appendix  to  the  Notes  on  Hospitals,  where,  it 
is  much  to  be  feared,  few  persons  ever  see  it, 
though  the  rare  pithiness,  acumen,  and  judgment 
shown  in  its  balancing  and  weighing  of  the  differ- 
ent systems  give  it  an  interest  and  a  value  far  too 
great  to  be  reconciled  with  oblivion.  In  its  acute 
observation  and  its  crisp,  fresh  comments  it  is 
delightfully  characteristic  of  its  author  and  con- 
tains some  of  her  most  pertinent  aphorisms. 

At  the  time  it  was  written,  it  gave  the  names 
of  certain  hospitals  as  examples  of  each  system 
described.  i\s,  however,  to-day,  many  of  these 
have  altered  their  schemes  of  nursing,  all  names 
have  been  omitted,  as  well  as  some  personal 
allusions. 

[It  may,  however,  be  noted  that,  at  the  present 
day,  there  may  still  be  found,  in  Italy,  many  ex- 
amples of  class  No.  I ;  that  examples  of  Class  2 
may  be  found  in  this  country  and  Canada;  that 
Class  3  is  illustrated,  in  this  country,  by  the  Cook 
County  hospital,  Chicago,  with  the  Illinois  train- 
ing school,  and  by  Bellevue  hospital  with  the 
school  attached  to  it;  that  the  General  hospital 
in  Vienna,  Austria,  which  was  mentioned  by  Miss 
Nightingale  as  belonging  in  Class  4,  still  belongs 
there,  with  unchanged  system,  and  that  Class  5 


Miss  Nightingale's  Writings       241 

includes  certain  military  hospitals,  and  depart- 
ments in  some  hospitals  for  the  insane.] 

ON     DIFFERENT     SYSTEMS     OF     HOSPITAL     NURSING     AS 
EXISTING     IN    THE    YEAR    1862 

In  the  important  question  of  accommodation  for 
nurses,  so  much  depends  upon  the  method  of  nursing 
chosen  that  an  appendix  is  devoted  to  this. 

The  methods  of  nursing  the  sick  [then]  adopted  in 
the  pubHc  hospitals  of  Europe  may  be  distinguished 
under  five  classes: 

1.  Where  the  nurses  belong  to  a  reHgious  order, 
and  are  under  their  own  spiritual  head:  the  hospital 
being  administered  by  a  separate  and  secular  govern- 
ing body. 

2.  Where  the  nurses  are  of  a  religious  order,  the 
head  of  which   administers  both  order  and  hospital. 

3.  Where  the  nurses  are  secular  under  their  own 
head :  the  hospital  having  its  own  separate  and  secu- 
lar gove  nmcnt. 

4.  Where  the  nurses  are  secular,  and  under  the 
same  secular  authority  as  that  by  which  the  hospital 
where  they  nu  se  is  governed. 

5.  Wi:ere  the  nurses  are  all  men  and  seculars  and 
under  the  same  secular  male  authority  as  the  hospital. 

Of  these  systems  of  nursing — 

No.  I,  where  the  nu  ses  belong  to  a  religious  order, 
and  are  under  their  own  spiritual  head — the  hospital 
being  administered  by  a  separate  and  secular  govern- 
ing body — is,  on  the  whole,  best  calcuated  to  secure 
good  nursing  for  the  sick,  and  the  general  well-being 
of  both  patients  and  nurses.   .   .  .     But  in  giving  this 

VOL.  II. — 1 6. 


242  A  History  of  Nursing 

unqualified  opinion  in  favour  of  nursing  by  sister- 
hoods, provided  the  administration  be  secular,  I  must 
add  a  caution  against  two  mistakes,  whether  commit- 
ted in  France  or  in  England,  in  Roman  Catholic  or  in 
Protestant  institutions,  viz.,  (i)  the  female  head  of  the 
Sisters  must  reside  in  the  institution  nursed  by  them 
and  neither  in  a  "nurses'  home,"  or  ''Maison  Mere,'' 
[which  is]  not  the  hospital,  nor  in  a  "home"  where 
other  w^orks  of  charity,  not  hospital  ones,  are  carried 
on.  If  she  has  other  works  of  charity  which  appear 
to  her  more  important,  then  she  had  better  not  under- 
take hospital  ones.  Hospital  nursing  is  jealous,  and 
demands  her  whole  heart.  It  will  not  have  a  divided 
allegiance.  It  will  not  be  too  much  of  her  whole  life 
to  gather  experience  and  learn  to  govern  such  institu- 
tions. If  she  has  several  hospitals,  as  the  Augustin- 
ians  of  Paris,  the  female  head  must  live  where  the 
novices,  or  probationers,  or  whatever  they  are  called, 
are  trained.  She  must  be  at  once  matron  of  the  hos- 
pital, which  means  of  the  nursing  of  it,  and  superin- 
tendent of  the  nurses.  It  will  not  do  for  her  to  head 
the  nurses  or  probationers  in  their  "home"  and  to 
leave  the  heading  of  them  in  the  hospital  to  a  matron, 
or  other  superior. 

No.  2.  The  Sisters  must  not  be  the  heads  of  wards 
merely  in  order  to  use  "moral  influence,"  as  the  inex- 
perienced sometimes  fancy  will  be  sufficient.  If  a 
lady  has,  in  addition,  the  same  knowledge  and  expe- 
rience as  an  old-fashioned  hospital  head  nurse,  which 
indeed  many  nuns,  but  only  in  secularly  governed 
hospitals,  have,  good:  she  is  fit  to  be  Sister  or  head 
nurse;  if  not,  not. 

No.  3,  where  the  nurses  are  secular  under  their  own 
secular  female  head — the  hospital  having  its  own  sep- 


Miss  Nightingale's  Writings       243 

arate  and  secular  government — is  unquestionably  the 
system  which  secures  the  best  nursing,  after  No.  i. 

Out  of  the  other  systems  of  nursing,  Nos.  2,4,  and  5, 
in  each  of  which  there  is  but  one  sole  authority,  al- 
though in  No.  2  a  religious  one,  in  Nos.  4  and  5  a  secu- 
lar one,  over  both  nurses  and  administration,  are 
equally  to  be  deprecated — 

Nos.  4  and  5  because  the  nurses,  whether  male  or 
female,  are  under  the  sole  command  of  the  male  hos- 
pital authorities:  in  this  case  the  arrangements  as 
to  hours,  proprieties,  and  sanitary  rules  generally, 
would  strike  any  one  as  all  but  crazy.  Such 
are  the  rules  which  give  nurses  twenty-four  hours 
"on  duty"  in  a  ward,  or  which  put  them  to 
sleep  with  the  sick,  of  which  the  extreme  case  is  where 
a  female  nurse  is  made  to  sleep  in  a  man's  ward,  etc. 

In  No.  2,  on  the  contrary,  the  nursing  staff,  whether 
Protestant  or  Roman  Catholic,  whether  its  heads  be 
male  or  female,  or  both,  is  in  entire  and  sole  command 
of  the  hospital:  in  this  case  the  arrangements  are 
generally  nearly  as  crazy  as  in  the  former,  although 
the  objects  and  results  are  widely  different.  Such 
are  the  letting  a  patient  die  of  a  bed-sore  because 
the  nurse  may  spread  the  dressing  for  it  but  must  not 
look  at  it ;  the  leaving  the  wards  at  night,  or  at  times 
when  the  "community"  assembles,  in  sole  charge  of 
subordinates. 

In  Case  No.  4  the  nurses  are  destroyed  bodily  and 
morally,  but  the  patients  are  generally,  not  always, 
better  nursed. 

In  Case  No.  2  the  patients  are  not  always,  but  gen- 
erally worse  nursed ;  the  sick  are  less  cared  for,  while 
the  spiritual  good  of  the  nurses  is  consulted.  But  the 
care  of  the  sick  is  the  object  of  hospitals. 


244  A  History  of  Nursing 

The  collision,  often  disagreeable,  but  generally  salu- 
tary for  the  care  of  the  sick,  between  the  secular 
administration  and  the  nursing  staff  (whether  this  con- 
sist of  nuns,  brothers,  deaconesses,  or  nurses),  as  is  the 
case  in  the  hospitals  of  London  and  Paris,  keeps  each 
belHgerent  party  to  his  duty,  and  reacts  beneficially 
on  the  interests  of  the  sick.  Even  the  mutual  imper- 
tinence, just  as  often  to  be  heard  between  nuns  and 
doctors  as  between  doctors  and  nurses,  is  far  better 
for  the  management  of  a  hospital,  and  any  neglect  of 
the  sick  is  far  less  likely  to  pass  unnoticed,  than  where 
the  authority  is  solely  invested  in  one  of  the  two  ways 
above  mentioned:  i.  e.,  either  vested  in  the  secular 
male  authorities  of  the  hospital,  or  in  the  spiritual 
head  of  the  nursing  establishment  by  either  Protestant 
or  Roman  Catholic  orders.  Take  the  nuns,  brothers, 
deaconesses  out  of  the  parent  institution,  and  set  them 
to  work  in  a  great  secular  hospital,  in  daily  contact 
with  the  (often  vexatious)  exigencies  of  doctors  and 
governors,  and  they  will  work  admirably. 

Take  Case  2.  Theory  differs  widely  from  prac- 
tice in  these  things.  If  we  were  perfect,  no  doubt  an 
absolute  hierarchy  would  be  the  best  kind  of  govern- 
ment for  all  institutions.  But,  in  our  imperfect  state 
of  conscience  and  enlightenment,  publicity,  and  the 
collision  resulting  from  publicity,  are  the  best  guard- 
ians of  the  interests  of  the  sick.  A  patient  is  much 
better  cared  for  in  an  institution  where  there  is  the 
perpetual  rub  between  doctors  and  nurses  or  nuns, 
between  students,  matrons,  governors,  treasurers, 
and  casual  visitors,  between  secular  and  spiritual 
authorities  (for  this  appHes  quite  as  much  to  Roman 
Catholic  as  to  Protestant  institutions)  than  in  a  hos- 
pital under  the  best  governed  order  in  existence  where 


Miss  Nightingale's  Writings       245 

the  chief  of  that  order,  be  it  male  or  female,  is  also  sole 
chief  of  the  hospital. 

Taking  the  imperfect  general  run  of  human  things 
— ^for  we  are  considering  men,  and  not  angels — public 
opinion  is  a  higher  average  standard  than  individual 
opinion.  For  many  years  I  have  been  trying  to  find 
how  this  could  be,  since  public  opinion  is  made  up  of 
individual  opinions.  I  think  it  is  because  A  will  be 
much  more  rigid  in  making  B  mind  B's  business  than 
in  minding  his  own.  Public  opinion  is  good  for  this. 
The  remark  is  not  a  high-minded  one,  but  it  is  true. 

Orders,  whether  Roman  CathoHc  or  Protestant, 
unless  held  in  check  by  the  rude  curb  of  public  opin- 
ion, or  by  the  perpetual  rub  and  collision  with  the  sec- 
lar  authority  of  the  hospital,  are  inclined  to  make  into 
a  special  object  the  spiritual  (often  fancied)  good  of 
their  members,  and  not  the  general  and  real  good  of 
the  inmates  of  the  hospital  (for  whom,  nevertheless, 
the  hospital  was  intended,  and  not  for  working  out 
the  salvation  of  the  order) . 

It  is  bad  for  the  activity  of  any  one  to  have 
always  his  own  way.  And  if  it  were  only  for 
this,  viz.,  that  no  great  sanitary  or  administrative 
improvements  have  ever  come  out  of  orders,  or  out  of 
seculars  whose  authority  is  undivided,  it  would  be 
enough  to  condemn  them. 

Nos.  2  and  4.  Where  the  nurses,  religious  or  secu- 
lar, are  governed  by  the  same  authority,  religious  or 
secular,  which  governs  the  hospital,  the  destruction  of 
health  of  the  members  both  of  orders  and  secular  in- 
stitutions often  takes  place  in  a  period  of  about  five 
years.  This  consumption  of  human  beings  is  the 
worst  policy  in  every  sense.  Its  operative  causes  are 
under- feeding,  want  of  proper  sleep,  want  of  the  most 


246  A  History  of  Nursing 

ordinary  sanitary  precaution — the  result  of  austerity 
in  orders,  of  an  ignorant  economy  in  secular  institu- 
tions. In  the  latter,  want  of  the  most  ordinary  means 
for   propriety   and   moraHty  is  often  a  fourth  cause. 

No.  2.  In  some  institutions  nursed  by  brother- 
hoods, abroad,  a  good  Augustinian  nun,  or  good  hos- 
pital nurse  from  London,  would  turn  everything  out 
of  window  (though  the  former  could  not  do  all  she 
wou  d  wish ) ,  and  be  as  disgusted  as  we  are  with  their 
pestilential  filth.  But,  al:s!  this  has  been  seen  even 
in  those  nursing  sisterhoods  where  the  salutary  check 
of  the  secular  administ  ation  was  not. 

No.  2.  Where  institution  and  sisterhood  alike  are 
under  the  same  authority.  The  following  remark 
applies  exclusively  to  orders,  and  to  orders  where  no 
secular  authority  is  in  play,  but  much  more  to  Protes- 
tant than  to  Roman  Catholic  orders,  which  latter 
have  better  sense : 

There  is  a  constant  change  of  occupation  of  each 
member  of  the  o  der,  for  the  sake  of  detaching  said 
member  f/om  earthly  things.  To-day  he  or  she  is  in 
the  kitchen,  to -mo.  row  in  a  surgical  ward,  next  week 
in  a  medical  w^ard,  the  week  af  er  in  he  laundry.  The 
perplexed  medical  attendant,  when  giving  his  direc- 
tions about  the  patients,  sees  a  new  face,  at  least  every 
fortnight,  to  give  his  direct'ons  to. 

In  the  best  Roman  Catholic  orders,  especially  where, 
as  in  I,  the  secular  authority  comes  into  action,  there 
is  far  more  lat  ude  given  to  individual  character,  and 
scope  to  individual  capacity,  than  we  are  at  all  aware 
of.  Each  member  is  much  more  independent  in  his 
or  her  own  occupation  than  is  the  case  under  arrange- 
ment No.  2. 

Nos.  2,4,  and  5.     Where  there  is  but  one  authority 


Miss  Nightingale's  Writings       247 

over  both  hospital  and  nurses,  whether  that  authority 
be  religious  or  secular.  The  following  remark  implies 
alike  to  some  institutions,  both  religious  and  secular, 
to  all  military,  and  to  some  civil,  to  Protestant  and 
Roman  Catholic  establishments: 

The  want  of  one  defini  e  head  in  permanent  charge 
of  each  ward,  or  set  of  wards,  invariably  acts  disas- 
trously for  the  patients.  There  should  always  be 
some  one  person  in  acknowledged  responsibility  for 
the  nursing,  wi  h  servants — call  them  lay  Sisters  or 
Brothers,  or  assistant  nurses,  or  what  you  will — un- 
der the  head. 

Religious  motives  in  some  orders,  a  want  of  any 
practical  ystem  of  nursing  in  many  military  and  some 
civil  hospitals,  reproduce  the  above  defect,  in  the  most 
varied  forms,  in  institutions  of  the  most  opposite 
character. 

No.  4.  Where  nurses  and  institutions  are  under 
the  same  secular  authority.  The  following  remark 
appHes  solely    o  institutions  secu'arly  nursed: 

The  practice  of  having  man  and  wife  in  oin  charge 
of  a  ward  or  wards  has  in  it  more  evil  than  good  for  the 
patien  s.  It  is  rue  that  a  woman  had  better  flirt 
with  her  husband  than  with  a  studen  or  patient:  it 
is  true  that  the  common  ph  ase  "settling"  (which 
means  marrying  in  some  classes)  has  its  significance 
here,  for  some  women  never  are  "settled"  till  they 
are  married.  But  it  is  no  less  true  that  the  interest 
of  the  husband  henceforth  c^me^  before  that  of  the 
patients,  in  hones'  as  in  dishonest  ways.  The  woman 
is  no  longer  attached  to  her  ward,  but  o  her  husband, 
and  the  patients  are,  more  or  less,  neglected.  This 
is  still  more  eminently  the  case  in  regimental  hospi- 
tals, where  it  is  a  common  practice  to  choose  married 


248  A  History  of  Nursing 

hospital  sergeants,  as  being  more  "respectable,"  and  to 
have  the  wife  to  live  in  the  hospital.  As  well  might 
the  hospital  head  nurse  have  her  husband  to  live  with 
her  in  the  room  off  her  ward. 

Nos.  I  (where  the  sisters  are  of  a  religious  order,  but 
the  nurses  are  secular) ,  3  and  4  (where  all  the  nurses 
are  secular,  whether  governed  by  a  separate  head 
from  that  which  governs  the  hospital,  or  by  the  same 
head).  The  cardinal  sin  of  paid  nu  ses,  of  all  classes, 
of  all  nations,  is  taking  petty  bribes  and  making  petty 
advantages  (of  many  different  sorts  and  sizes)  out  of 
the  patients.  From  this  sin  all  orders,  whether  Ro- 
man Catholic  or  Protestant,  are  exempt,  but  from 
it  their  servants  are  by  no  means  exempt. 

The  rules  of  hospital  head  nurses  in  London,  were 
they  really  religious  women,  who  would  neither  take 
any  present  themselves,  nor  be  guilty  of  any  kind  of 
impropriety,  would  enable  them  to  exercise  a  far  more 
efficient  surveillance  over  assistant  nurses,  as  to  both 
these  things,  than  can  be  exercised  by  Roman  Cath- 
olic or  Protestant  orders  living  in  community.  All 
kinds  of  things  between  nurses  and  patients  may  and 
do  go  on  in  the  Sisters'  wards,  when  the  listers  are  out 
of  the  way.  A  hospital  head  nurse  is  (or  ought  to  be) 
always  in  command  of  her  ward. 

To  sum  up:  Case  i.  There  is  a  higher  average  of 
care  of  the  sick  and  a  higher  universal  sense  of  moral- 
ity among  hospital  Sisters,  Protestant  and  Roman 
Catholic,  provided  the  hospital  authority  be  a  secular 
one.  Case  2.  There  is  a  lower  average  care  of  the 
sick,  although  an  equally  high  morality,  among  hos- 
pital nuns,  Protestant  and  Roman  Catholic,  if  the 
hospital  authority  be  not  a  secular  one.  Case  3. 
There  is  a  far  greater  average  care  of  the  sick,  although 


Miss  Nightingale's  Writings       249 

a  lower  morality,  among  nurses  under  a  secular  female 
head,  the  authority  of  the  hospital  being  a  secular 
and  separate  one,  than  in  Case  2  :  and  there  is  a  some- 
what higher  average  care  of  the  sick  in  Case  4  than 
in  Case  2,  and  no  morality  at  all,  but  an  awful  destruc- 
tion of  both  life  and  soul,  among  nurses,  where  both 
nurses  and  hospital  are  under  the  same  secular  (male) 
authority.  Case  5.  There  is  no  care  of  the  sick  and 
no  morality,  not  even  discipline,  in  hospitals  where 
the  nurses  are  men,  and  where  both  nurses  and  hos- 
pital are  under  the  same  secular  (male)  authority. 
This  is  the  worst  state  of  things  of  all.  Case  2  is  per- 
haps the  second  worse.  For,  take  it  which  way  you 
will,  the  idea  of  the  "religious  order"  is  always,  more 
or  less,  to  prepare  the  sick  for  death:  of  the  secular, 
to  restore  them  to  life.  And  their  nursing  will  be 
accordingly.  There  will  be  instances  of  physical  neg- 
lect (though  generally  unintentional)  on  the  part  of 
the  former:  of  moral  neglect  on  that  of  the 
latter.  Unite  the  two,  and  there  will  be  fewer  of 
either. 

Of  course  to  all  this  there  are  exceptions.  This 
appendix  is  dealing  only  with  systems  of  nursing  as 
systems.  ^ 

The  proper  position  of  the  matron  or  head  of 
the  nurses  has  been  defined  by  Miss  Nightingale 
with  insistent  reiteration.  It  is  a  point  she  never 
fails  to  dwell  on,  and  often  recurs  to  in  her  writ- 
ings. In  one  of  her  first  papers  on  hospital  organ- 
isation she  says : 

1  From  Notes  on  Hospitals,  by  permission  of  the  pub- 
lishers, Longmans,  Green  &  Co.,  London. 


250  A  History  of  Nursing 

"Equal  in  importance  to  the  provision  of  trained 
nurses  is  the  nature  of  the  hospital  authority  under 
which  these  nurses  are  to  perform  their  duties.  For, 
unless  an  understanding  is  come  to  on  this  point  the 
very  existence  of  good  nursing  is  an  impossibility.  In 
dealing  with  this  question  I  may  state  at  once  that  to 
turn  any  number  of  trained  niu-ses  into  any  workhouse 
infirmary  to  act  under  the  superintendent  or  the  in- 
structions of  any  workhouse  master  or  matron  or 
medical  officer  would  be  sheer  waste  of  good  money. 
This  is  not  matter  of  opinion  but  of  fact  and  experi- 
ence. .  .  .  Experienced  administrators  will  scarcely 
suppose  that  I  mean  to  imply  an  independence  or  to 
ask  for  uncontrolled  hospital  authority  for  the  nursing 
staff.  .  .  .  The  matron  or  nursing  superintendent 
must  be  held  responsible  for  her  own  efficiency  and 
the  efficiency  of  all  her  nurses  and  servants.  .  .  .  All 
that  the  medical  department  or  the  governing  body 
has  a  right  to  require  is  that  the  regulation  duties 
shall  be  faithfully  performed.  .  .  .  Neither  the  med- 
ical officer  nor  an}'  other  male  head  should  ever  have 
the  power  to  punish  ...  his  duty  should  end  with 
reporting  the  case  to  the  female  head.   .   .   A 

Again,  on  this  point,  she  '^Tote: 

I  may  perhaps  again  point  out  that  the  superin- 
tendent should  herself  be  responsible  to  the  consti- 
tuted hospital  authorities  and  that  all  her  nurses  and 
servants  should,  in  the  performance  of  these  duties, 
be  responsible  to  the  superintendent  only. 

»  From  a  paper  on  training  and  organising  nurses  for  the 
sick  poor  in  workhouse  infirmaries  in  Accounts  and  Papers, 
vol.  Ix.  "  Metropolitan  Workhouses."     1S67. 


Miss  Nightingale's  Writings       251 

No  good  ever  comes  of  the  constituted  authorities 
placing  themselves  in  the  office  which  they  have  sanc- 
tioned her  occupying. 

No  good  ever  comes  of  any  one  interfering  between 
the  head  of  the  nursing  establishment  and  her  nurses. 
It  is  fatal  to  discipline. 

All  complaints  on  any  subject  should  be  made  di- 
rectly to  the  superintendent,  and  not  to  any  nurse  or 
servant. 

She  should  be  made  responsible,  too,  for  her  results, 
and  not  for  her  methods. 

Of  course,  if  she  does  not  exercise  the  authority 
entrusted  to  her  with  judgment  and  discretion,  it  is 
then  the  legitimate  province  of  the  governing  body  to 
interfere,  and  to  remove  her. 

It  is  necessary  to  dwell  strongly  on  this  point,  be- 
cause there  has  been  not  unfrequently  a  disposition 
shown  to  make  the  nursing  establishment  responsible 
on  the  side  of  di  cipline  to  the  medical  officer,  or  the 
governor  of  a  hospital. 

Any  attempt  to  introduce  such  a  system  would  be 
merely  to  try  anew  and  fail  anew  in  an  attempt  which 
has  frequently  been  made.  n  disciplinary  matters  a 
woman  only  can  understand  a  woman. 

It  is  the  duty  of  a  medical  officer  to  give  what  orders, 
in  regard  to  the  sick,  he  thinks  fit,  to  the  nurses.  And 
it  is  unquestionably  the  duty  of  the  nurses  to  obey  or 
see  his  orders  carried  out. 

Simplicity  of  rules,  placing  the  nurses  in  all  matters 
regarding  management  of  sick  absolutely  under  the 
orders  of  the  medical  men,  and  all  disciplinary  matters 
absolutely  under  the  female  superintendent  matron), 
to  whom  the  medical  officers  should  report  all  cases 
of  neglect,  is  very  important.     At  the  outset  there 


252  A  History  of  Nursing 

must  be  a  clear  and  recorded  definition  of  the  limits 
of  these  two  classes  of  jurisdiction. 

The  matron  must  be  one  whose  desire  is  that  the 
probationers  shall  learn ;  a  rarer  thing  than  is  usually 
supposed. 

But  beside  this  there  is  a  constant,  motherly,  in- 
tangible super\ision  and  observation  to  be  exercised, 
for  there  are  qualities  which  no  written  tests  and  no 
examination  can  reach.  The  probationers  must  really 
be  the  matron's  children:  the  "home "Sister  must 
really  be  their  elder  sister. 

A  training  school  without  a  mother  is  worse  than 
children  without  parents.  And  in  disciplinary  mat- 
ters none  but  a  woman  can  understand  a  woman. 

In  view  of  some  modern  tendencies  these  words 
of  Miss  Nightingale  are  also  of  interest : 

With  regard  to  an  oft-disputed  question  whether 
it  is  desirable  to  train  probationers  entirely  in  a  public 
hospital  I  should  say,  without  hesitation,  it  is  there 
only  that  they  can  be  trained ;  and  every  well-judging 
superintendent  will  tell  s^ou  that  the  students,  gov- 
ernors, stewards,  etc.  (disagreeable  as  the  collisions 
with  them  sometimes  are),  are  the  most  valuable 
assets  in  the  training  of  her  nurses.  Whether  in  op- 
position or  in  kindness  she  hears  of  all  their  short- 
comings through  the  secular  bystand.rs  which  she 
would  hear  of  in  no  other  way.  I  have  rarely  known 
a  nurse  worth  tne  bread  she  ate — Catholic,  Lutheran, 
or  AngHcan  Sister  or  paid — who  had  not  been  trained 
under  a  hospital  discipline  consisting  partly    of   the 


Miss  Nightingale's  Writings       253 

secular  man  authority  of  the  hospital  and  partly  of  her 
own  female  superintendent.  I  don't  know  which  is  the 
worst  managed — the  hospital  which  is  entirely  under 
the  secular  men  heads,  or  the  hospital  which  is  entirely 
under  the  superintendent  of  the  nurses,  whether  relig- 
ious or  secular,  whether  male  or  female."  ^ 

So,  too,  in  principles  of  training  hers  are  the 
most  clear-cut  definitions,  penetrating,  complete, 
and  unanswerable.  In  small  domestic  or  local  de- 
tails time  and  varied  conditions  may  easily  prove 
some  of  her  directions  to  be  out  of  date,  as  when 
she  insists  that  the  nurse  should  always  live  in  the 
hospital  (it  is  to  be  remembered,  though,  here, 
that  what  she  was  contending  against  was  a  sys- 
tem which  allowed  the  nurse  to  be  a  married  wo- 
man living  at  home  with  her  family  and  coming 
by  day  or  by  night  only  to  the  ward) ,  or  when  she 
says  that  the  Sister  should  command  her  ward 
day  and  night,  meaning  that  the  head  nurse  must 
have  her  living  and  sleeping  room  adjacent  to  or 
even  opening  out  of  the  ward, — but  her  ethics  and 
principles  are  for  all  time. 

Training  is  to  teach  not  only  what  is  to  be  done,  but 
how  to  do  it.  The  physician  or  surgeon  orders  what 
is  to  be  done.  Training  is  to  teach  the  nurse  how  to 
do  it  to  his  order,  and  to  teach  not  only  how  to  do 
it,  but  why  such  and  such  a  thing  is  done,  and  not  such 
and  such  another  ;  as  also  to  teach  symptoms,  and 

1  Quoted  in  article :  "  Training  Schools  for  Nurses,"  Jour- 
nal of  Social  Science  (Transactions  of  the  American  Associa- 
tion), by  F.  B.  S.,p.  294,  September,  1874. 


254  A  History  of  Nursing 

u'hat  symptoms  indicate  what  of  disease  or  change, 
and  the  "reason  why"  of  such  symptoms. 

Nearly  all  physicians'  orders  are  conditional.  Tell- 
ing the  nurse  what  to  do  is  not  enough  and  cannot  be 
enough  to  perfect  her,  whatever  her  surroundings. 
The  trained  power  of  attending  to  one's  own  impres- 
sions made  by  one's  own  senses,  so  that  these  should 
tell  the  nurse  how  the  patient  is,  is  the  sine  qua  non 
of  being  a  nurse  at  all.  The  nurse's  eye  and  ear  must 
be  trained ;  smell  and  touch  are  her  two  right  hands — ■ 
and  her  taste  is  sometimes  as  necessary  to  the  nurse 
as  her  head.  Observation  may  always  be  improved 
by  training,  will  indeed  seldom  be  found  without 
training:  for  otherwise  the  nurse  does  not  know  what 
to  look  for.  Merely  looking  at  the  sick  is  not  observ- 
ing. To  look  is  not  always  to  see.  It  needs  a  high 
degree  of  training  to  look  so  that  looking  shall  tell 
the  nurse  aright,  so  that  she  may  tell  the  medical  offi- 
cer aright  what  has  happened  in  his  absence — a  higher 
degree  in  medical  than  in  surgical  cases,  because  the 
wound  may  tell  its  own  tale  in  some  respects;  but 
highest  of  all,  of  course,  in  children's  cases,  because 
the  child  cannot  tell  its  own  tale:  it  cannot  always 
answer  questions.  A  conscientious  niu-se  is  not  neces- 
sarily an  observing  nurse,  and  life  or  death  may  lie 
T^dth  the  good  observer.  Without  a  trained  power 
of  observation,  the  nurse  cannot  be  of  any  use  in  re- 
porting to  the  medical  attendant.  The  best  one  can 
hope  for  is  that  he  will  be  clever  enough  not  to  mind 
her,  as  is  so  often  the  case.  Without  a  trained  power 
of  observation,  neither  can  the  nurse  obey  intelligently 
his  directions.  It  is  most  important  to  observe  the 
symptoms  of  illness;  it  is,  if  possible,  more  important 
gtill  to  observe  the  symptoms  of  nursing:  of  what  is 


Miss  Nightingale's  Writings       255 

the  fault  not  oT  the  illness,  but  of  the  nursing.  Ob- 
servation tells  how  the  patient  is ;  reflection  tells  what 
is  to  be  done.  Training  and  experience  are,  of  course, 
necessary  to  teach  us,  too,  how  to  observe,  what  to 
observe,  how  to  think,  what  to  think.  Observa- 
tion tells  us  the  fact,  reflection  the  meaning  of 
the  fact.  Reflection  needs  training  as  much  as 
observation.  To  obey  is  to  understand  orders,  and 
to  understand  orders  is  really  to  obey.  A  nurse  does 
not  know  how  to  do  what  she  is  told  without  such 
"training"  as  enables  her  to  understand  what  she  is 
told,  or  without  such  moral  disciplinary  "training"  as 
enables  her  to  give  her  whole  self  to  obey.  A  woman 
cannot  be  a  good  and  intelligent  nurse  without  being 
a  good  and  intelligent  woman.  Therefore,  what 
"training  "  signifies  in  the  wide  sense,  what  makes 
a  good  training  school,  what  moral  and  discipHnary 
"training"  means,  and  how  it  is  to  be  obtained,  is  to 
be  clearly  understood. 

The  essentials  of  a  training  school  (or,  indeed,  for  a 
nurse-establishment  of  any  kind)  may  be  shortly  given 
thus: 

(a)  That  nurses  should  be  technically  trained  in 
hospitals  organised  for  the  purpose. 

(b)  That  they  should  live  in  "homes"  fit  to  form 
their  moral  lives  and  discipline. 

The  untrained  nurse,  like  other  people  called  quacks, 
easily  falls  into  the  confusion  of  on  account  of,  because 
after — the  blunder  of  the  "three  crows."  The  nurse 
is  told  by  the  medical  attendant,  "If  such  and  such 
a  change  occur,  or  if  such  or  such  symptoms  appear, 
you  are  to  do  so  and  so,  or  to  vary  my  treatment  in 
such  and  such  a  manner."  In  no  case  is  the  physician 
or   surgeon   always   there.     The   woman  must   have 


256  A  History  of  Nursing 

trained  powers  of  observation  and  reflection,  or  she 
cannot  obey.  The  patient's  Ufe  is  lost  by  her  blunders, 
or  "  sequelae  "  of  incurable  infirmity  make  after-life  a 
long  disease,  and  people  say,  "The  doctor  is  to  blame ;" 
or,  worse  still,  they  talk  of  it  as  if  God  were  to  blame — 
as  if  it  were  God's  will.  God's  will  is  not  that  we 
should  leave  our  nurses,  in  whose  hands  w^e  must  leave 
issues  of  Hfe  or  death,  without  training  to  fulfil  the 
responsibilities  of  such  momentous  issues. 

A  nurse  without  training  is  like  a  man  who  has 
never  learnt  his  alphabet,  who  has  learnt  experience 
only  from  his  own  blunders.  Blunders  in  executing 
physicians'  or  surgeons'  orders  upon  the  living  body 
are  hazardous  things,  and  may  kill  the  patient.  Train- 
ing is  to  enable  the  nurse  to  see  what  she  sees — ^facts ; 
and  to  do  what  she  is  told,  to  obey  orders  not  only 
from  the  rule  of  thumb,  but  by  having  the  rule 
of  thought,  of  observation,  to  guide  her.  Otherwise 
she  finds  out  her  own  mistakes  by  experience,  ac- 
quired out  of  death  rather  than  life,  or  does  not  find 
them  at  all. 

.  .  .  Training  is  to  teach  a  nurse  to  know  all  her 
business,  that  is,  to  observe  exactly,  to  understand, 
to  know  exactly,  to  do,  to  tell  exactly,  in  such  stu- 
pendous issues  as  life  and  death,  health  and  disease. 
Training  is  to  enable  the  nurse  to  act  for  the  best  in 
carrying  out  her  orders,  not  as  a  machine,  but  as  a 
nurse;  not  like  Cornelius  Agrippa's  broomstick  which 
went  on  carrying  water,  but  like  an  intelligent  and 
responsible  being.  Training  has  to  make  her,  not 
servile,  but  loyal  to  medical  orders  and  authorities. 
True  loyalty  to  orders  cannot  be  without  the  inde- 
pendent sense  or  energy  of  responsibility,  which  alone 
secures    real    trustworthiness.     Training    makes    the 


Miss  Nightingale's  Writings       257 

difference  in  a  nurse  that  is  made  in  a  student  by  mak- 
ing him  prepare  specimens  for  himself  instead  of 
merely  looking  at  the  prepared  specimens.  Training 
is  to  teach  the  nurse  how  to  handle  the  agencies  within 
our  control  which  restore  health  and  life,  in  strict 
obedience  to  the  physician's  or  surgeon's  power  and 
knowledge,  how  to  keep  the  health  mechanism  pre- 
scribed to  her  in  gear.  Training  must  show  her  how 
the  effects  of  life  on  nursing  may  be  calculated  with 
nice  precision — such  care  or  carelessness,  such  a  sick 
rate ;  such  a  duration  of  case,  such  a  death-rate. 

And  discipline  is  the  essence  of  training. 

.  .  .  Discipline  embraces  order,  method,  and,  as 
we  gain  some  knowledge  of  the  laws  of  nature  (God's 
laws)  we  not  only  see  order,  method,  a  place  for  every- 
thing, each  its  own  work,  but  we  find  no  waste  of  ma- 
terial or  force  or  space ;  we  find,  too,  no  hurry,  and  we 
learn  to  have  patience  with  our  circumstances  and 
ourselves,  and  so,  as  we  go  on  learning,  we  become 
more  content  to  work  where  we  are  placed,  more  anx- 
ious to  fill  our  appointed  work  than  to  see  the  result 
thereof;  and  so  God,  no  doubt,  gives  us  the  required 
patience  and  steadfastness  to  continue  in  our  "blessed 
drudgery, "which  is  the  discipline  he  sees  best  for  most 
of  us."i 


What  a  Nurse  is  to  Be. — ^A  really  good  nurse  must 
needs  be  of  the  highest  class  of  character.  It  needs 
hardly  be  said  that  she  must  be  (i)  chaste,  in  the  sense 
of  the  Sermon  on  the  Mount — a  good  nurse   should 

^Frorn  "  The  Training  of  Nurses,"   Quain's  Dictionary  oj 
Medicine,  ed.   of    1894.     By  permission    of    the   publishers. 
Longmans,  Green  &  Co.,  London. 
Vol.  11. — 17 


258  A  History  of  Nursing 

be  the  Sermon  on  the  Mount  herself.  It  should  nat- 
urally seem  impossible  to  the  most  unchaste  to  utter 
even  an  immodest  jest  in  her  presence.  Remember 
this  great  and  dangerous  peculiarity  of  nursing,  and 
especially  of  hospital  nursing,  namely,  that  it  is  the 
only  case,  queens  not  excepted,  where  a  woman  is 
really  in  charge  of  men.  And  a  really  good,  trained 
ward  "Sister"  can  keep  order  in  a  men's  ward  better 
than  a  military  ward-master  or  sergeant.  (2)  Sober, 
in  spirit  as  well  as  in  drink,  and  temperate  in  all 
things.  (3)  Honest,  not  accepting  the  trifling  fee  or 
bribe  from  the  patients  or  friends.  (4)  Truthful,  and 
to  be  able  to  tell  the  truth  includes  attention  and  ob- 
servation, to  observe  truly;  memory,  to  remember 
truly;  power  of  expression,  to  tell  truly  what  one  has 
observed  truly ;  as  well  as  intention  to  speak  the  truth ; 
the  whole  truth,  and  nothing  but  the  truth.  (5) 
Trustworthy,  to  carry  out  directions  intelligently  and 
perfectly,  unseen  as  well  as  seen,  "to  the  Lord  "  as  well 
as  unto  men — no  mere  eye-service.  (6)  Punctual 
to  a  second,  and  orderly  to  a  hair — having  everything 
ready  in  order  before  she  begins  her  dressings  or  her 
work  about  the  patients:  nothing  iorgotten.  (7) 
Quiet,  yet  quick:  quick  wil^out  hurry,  gentle  without 
slowness;  discreet  without  self-importance,  no  gossip. 
(8)  Cheerful,  hopeful,  nolT  allowing  herself  to  be  dis- 
couraged by  unfavourable  symptoms;  not  given  to 
distress  the  patient  by  anticipations  of  an  unfavour- 
able result.  (9)  Cleanly  to  the  point  of  exquisitenesi:; 
both  for  the  patient's  sake  and  for  her  own;  neat  and 
ready.  (10)  Thinking  of  her  patient  and  not  of  her- 
self, "tender  over  his  occasions"  or  wants,  cheerful 
and  kindly,  patient,  ingenious  and  feat.  The 
best  definition   can  be   found,  as  always,  in   Shakes- 


Miss  Nightingale's  Writings       259 

peare,   where   he   says   that    to    be    "nurse-like"    is 

to  be — 

**So  kind,  so  duteous,  diligent, 
So  tender  over  his  occasions,  true, 
So  feat."  1 

The  most  remarkable  summing-up  of  all  her 
previous  dicta  on  training  and  ideals  is  found  in 
the  paper  which  Miss  Nightingale  contributed  to 
the  Nursing  Section  of  the  Congress  on  Hospitals, 
Dispensaries,  and  Nursing  at  the  time  of  the 
World's  Fair  in  Chicago.  In  reading  this  paper, 
masterly  in  its  scope  and  grasp,  it  seems  as  if  Miss 
Nightingale  must  have  foreseen,  in  prophetic  vis- 
ion, the  mushroom  growth  of  the  quackery  which 
had  not  then  developed,  but  which  has  since 
grown  to  menacing  proportions.  Had  she  then 
read  the  flowery  circulars  issued  by  commercial 
enterprises,  belittling  the  practical  and  the  disci- 
plinary training,  and  lauding  to  the  skies  all  that 
is  superficial  and  flimsy,  she  could  not  better  have 
answered  their  sophistries.  But  by  one  of  the 
ironies  of  fate,  and  a  lamentable  one,  she  foresees 
the  wave  of  pinchbeck  nursing  education  as  some- 
thing linked  with  regulation  and  examination  by 
the  state  or  an  authorised  central  body,  instead  of, 
as  it  actually  is,  the  irreconcilable  enemy  of  state 
protective  legislation,  which  demands  practical 
service  as  the  sine  qud  non  for  obtaining  its  shield 
and  aegis. 

1"  Nursing  the  Sick."  Quain's  Dictionary  of  Medicine^ 
ed.  of  1894.  By  permission  of  the  publishers,  Longmans, 
Green  &  Co.,  London. 


26o  A  History  of  Nursing 

And  so  throughout  this  impressive  address  runs 
an  appeal  to  the  nurses  of  America  not  to  do  this 
thing  which  they  have  done  and  have  had  to  do 
in  order  to  strengthen  the  basis  of  sound  hospital 
training  against  the  sapping  of  teaching  by  corre- 
spondence and  by  the  elimination  of  all  real  work. 
When  this  paper  was  read  before  the  American 
nurses  none  of  them  could  have  foreseen  that  ten 
years  after  they  had  heard  it  they  would  be  stead- 
fastly and  unitedly  banded  together  against  sham 
in  nursing  education.  That,  in  so  doing  they 
have  done  what  ]\Iiss  Nightingale  herself  would 
have  done,  and  have  kept  before  them  her  own 
standard,  cannot  be  doubted;  that  in  so  doing 
they  have  taken  a  road  which  she  believes  to  be 
astray,  the  road  of  state  protection  for  a  fixed 
basis  of  requirement,  has  been  inevitable,  and  in 
this  necessary  divergence  lies  much  that  is  to  be 
deplored,  for  it  has  meant  an  apparent  disregard 
of  the  advice  of  one  whose  advancing  years  and 
honour  call  for  all  respect  and  consideration. 

I,  A  new  art  and  a  new  science  has  been  created 
since  and  within  the  last  forty  years.  And  with  it  a 
new  profession — so  they  say:  we  say,  calling.  One 
would  think  this  had  been  created  or  discovered  for 
some  new  want  or  local  want.  Not  so.  The  want  is 
nearly  as  old  as  the  world,  nearly  as  large  as  the  world, 
as  pressing  as  life  or  death.  It  is  that  of  sickness. 
And  the  art  is  that  of  nursing  the  sick.  Please  mark — 
nursing  the  sick,  not  nursing  sickness.  We  will  call 
the  art  nursing  proper.     This  is  generally  practised  by 


Miss  Nightingale's  Writings       261 

women  under  scientific  heads — physicians  and  sur- 
geons. This  is  one  of  the  distinctions  between  nursing 
proper  and  medicine,  though  a  very  famous  and  suc- 
cessful physician  did  say,  when  asked  how  he  treated 
pneumonia,  "I  do  not  treat  pneimionia.  I  treat  the 
person  who  has  pneumonia."  This  is  the  reason  why 
nursing  proper  can  only  be  taught  by  the  patient's 
bedside,  and  in  the  sick-room  or  ward.  Neither  can 
it  be  taught  by  lectures  or  by  books,  though  these  are 
valuable  accessories,  if  used  as  such;  otherwise,  what 
is  in  the  book  stays  in  the  book. 


II.  But,  since  God  did  not  mean  mothers  to  be 
always  accompanied  by  doctors,  there  is  a  want  older 
still  and  larger  still.  And  a  new  science  has  also  been 
created  to  meet  it,  but  not  the  accompanying  art,  as 
far  as  the  households  are  concerned,  families,  schools, 
workshops,  though  it  is  an  art  which  concerns  every 
family  in  the  world,  which  can  only  be  taught  from 
the  home,  in  the  home. 

This  is  the  art  of  health,  which  every  mother,  girl, 
mistress,  teacher,  child's  nurse,  every  woman  ought 
practically  to  learn.  But  she  is  supposed  to  know  it 
all  by  instinct,  like  a  bird.  Call  it  health  nursing  or 
general  nursing — what  you  please.  Upon  womankind 
the  national  health,  as  far  as  the  household  goes,  de- 
pends. She  must  recognise  the  laws  of  life,  the  laws  of 
health,  as  the  nurse  proper  must  recognise  the  laws 
of  sickness,  the  causes  of  sickness,  the  symptoms  of 
the  disease,  or  the  symptoms,  it  may  be,  not  of  the 
disease,  but  of  the  nursing,  bad  or  good. 

It  is  the  want  of  the  art  of  health,  then,  of  the 
cultivation    of    health,   which    has  only   lately    been 


262  A  History  of  Nursing 

discovered,  and  great  organisations  have  been  made 
to  meet  it,  and  a  whole  literature  created.  We  have 
medical  officers  of  health,  immense  sanitary  works. 
We  have  not  nurses,  "missioners"  of  health- at- home. 

How  to  bring  these  great  medical  officers  to  bear  on 
the  families,  the  homes  and  households,  and  habits  of 
the  people,  rich  as  well  as  poor,  has  not  been  dis- 
covered, although  family  comes  before  Acts  of  Parlia- 
ment. One  would  think  ''family  "  had  no  health  to  look 
after.  And  woman,  the  great  mistress  of  family  life, 
by  whom  everybody  is  born,  has  not  been  practically 
instructed  at  all.  Everything  has  come  before  health. 
We  are  not  to  look  after  health,  but  after  sickness. 
Well,  we  are  to  be  convinced  of  error  before  we  are 
convinced  of  right :  the  discovery  of  sin  comes  before 
the  discovery  of  righteousness,  we  are  told  on  the 
highest  authority. 

Though  everybody  must  be  born,  there  is  probably 
no  knowledge  more  neglected  than  this,  nor  more 
important  for  the  great  mass  of  w^omen,  viz.,  how  to 
feed,  wash,  and  clothe  the  baby,  and  how  to  secure  the 
utmost  cleanliness  for  mother  and  infant.  Midwives 
certainly  neither  practise  nor  teach  it.  And  I  have 
even  been  informed  that  many  lady  doctors  consider 
that  they  have  "nothing  to  do  with  the  baby,"  and 
that  they  should  "lose  caste  with  the  men  doctors"  if 
they  attempted  it.  One  would  have  thought  that  the 
ladies  "lost  caste"  with  themselves  for  not  doing 
it,  and  that  it  was  the  very  reason  why  we  wished  for 
the  "lady  doctors,"  for  them  to  assume  these  cares 
which  touch  the  very  health  of  everybody  from  the 
beginning.  But  I  have  known  the  most  admirable 
exceptions  to  this  most  cruel  rule. 

I  know  of  no  systematic  teaching,  for  the  ordinary 


Miss  Nightingale's  Writings       263 

midwife  or  the  ordinary  mother,  how  to  keep  the  baby 
in  health,  certainly  the  most  important  function  to 
make  a  healthy  nation.  The  human  baby  is  not  an 
invalid,  but  it  is  the  most  tender  form  of  animal  life. 
This  is  only  one,  but  a  supremely  important  instance 
of  the  want  of  health-nursing. 


III.  As  the  discovery  of  error  comes  before  that 
of  right,  both  in  order  and  in  fact,  we  will  take  first 
(a)  sickness,  nursing  the  sick:  training  needful;  (b) 
health,  nursing  the  well  at  home:  practical  teaching 
needful.  We  will  then  refer  (IV)  to  some  dangers  to 
which  nurses  are  subject,  (V)  benefit  of  combination, 
and  (VI)  our  hopes  for  the  future. 

What  is  sickness?  Sickness  or  disease  is  nature's 
way  of  getting  rid  of  the  effects  of  conditions  which 
have  interfered  with  health.  It  is  nature's  attempt 
to  cure.  We  have  to  help  her.  Diseases  are,  practi- 
cally speaking,  adjectives,  not  noun  substantives. 
What  is  health?  Health  is  not  only  to  be  well,  but 
to  be  able  to  use  well  every  power  we  have.  What 
is  nursing?  Both  kinds  of  nursing  are  to  put  us  in 
the  best  possible  conditions  for  nature  to  restore  or  to 
preserve  health,  to  prevent  or  to  cure  disease  or  injury. 
Upon  nursing  proper,  under  scientific  heads,  physi- 
cians or  surgeons  must  depend  partly,  perhaps  mainly, 
whether  nature  succeeds  or  fails  in  her  attempts  to 
cure  by  sickness.  Nursing  proper  is  therefore  to  help 
the  patient  suffering  from  disease  to  live,  just  as  health 
nursing  is  to  keep  or  put  the  constitution  of  the 
healthy  child  or  human  being  in  such  a  state  as  to 
have  no  disease. 


264  A  History  of  Nursing 

What  is  training?  Training  is  to  teach  the  nurse 
to  help  the  patient  to  Hve.  Nursing  the  sick  is  an  art, 
and  an  art  requiring  an  organised,  practical  and  scien- 
tific training,  for  nursing  is  the  skilled  servant  of  med- 
icine, surgery,  and  hygiene.  A  good  nurse  of  twenty 
years  ago  had  not  to  do  the  twentieth  part  of  what 
she  is  required  by  her  physician  or  surgeon  to  do  now ; 
and  so,  after  the  year's  training,  she.  must  be  still 
training  under  instruction  in  her  first  and  even  second 
year's  hospital  service.  The  physician  prescribes  for 
supplying  the  vital  force,  but  the  nurse  supplies  it. 
Training  is  to  teach  the  nurse  how  God  makes  health, 
and  how  He  makes  disease.  Training  is  to  teach  a 
nurse  to  know  her  business,  that  is,  to  observe  exactly 
in  such  stupendous  issues  as  life  and  death,  health  and 
disease.  Training  has  to  make  her,  not  servile,  but 
loyal  to  medical  orders  and  authorities.  True  loy- 
alty to  orders  cannot  be  without  the  independent 
sense  or  energy  of  responsibility,  which  alone  secures 
real  trustworthiness.  Training  is  to  teach  the  nurse 
how  to  handle  the  agencies  within  our  control  which 
restore  health  and  life,  in  strict,  intelligent  obedience 
to  the  physician's  or  surgeon's  power  and  knowledge: 
how  to  keep  the  health  mechanism  prescribed  to  her 
in  gear.  Training  must  show  her  how  the  effects  on 
life  of  nursing  may  be  calculated  with  nice  precision 
— such  care  or  carelessness,  such  a  sick-rate;  such  a 
duration  of  case,  such  a  death-rate. 

What  is  discipline?  Discipline  is  the  essence  of 
moral  training.  The  best  lady  trainer  of  proba- 
tioner nurses  I  know  says:  "It  is  education,  instruc- 
tion, training — all  that,  in  fact,  goes  to  the  full 
development  of  our  faculties,  moral,  physical  and 
spiritual,  not  onl}^  for  this  life,  but  looking  on  this 


Miss  Nightingale's  Writings       265 

life  as  the  training  ground  for  the  future  and  higher 
Hfe.     .     .     ." 

What  makes  a  good  training  school  for  nurses? 
The  most  favourable  conditions  for  the  administration 
of  the  hospital  are ; 

First.  A  good  lay  administration  with  a  chief  ex- 
ecutive officer,  a  civilian  (be  he  called  treasurer  or 
permanent  chairman  of  committee),  with  power 
delegated  to  him  by  the  committee,  who  gives  his 
time.  This  is  the  main  thing.  With  a  consulting 
committee,  meeting  regularly,  of  business  men,  taking 
the  opinions  of  the  medical  officers.  The  medical 
officers  on  the  committee  must  be  only  consulting 
medical  officers,  not  executive.  If  the  latter,  the]^ 
have  often  to  judge  in  their  own  case,  which  is  fata^ 
Doctors  are  not  necessarily  administrators  (the  exec- 
utive), any  more  than  the  executive  are  necessarily 
doctors.  Vest  the  charge  of  financial  matters  and 
general  supervision,  and  the  whole  administration 
of  the  hospital  or  infirmary,  in  the  board  or  committee 
acting  through  the  permanent  chairman  or  other  of- 
ficer who  is  responsible  to  that  board  or  committee. 

Second.  A  strong  body  of  medical  officers,  vis- 
iting and  resident,  and  a  medical  school. 

Third.  The  government  of  hospitals,  in  the 
point  of  view  of  the  real  responsibility  for  the  conduct 
and  discipline  of  the  nurses,  being  thrown  upon  the 
matron  (superintendent  of  nurses),  who  is  herself  a 
trained  nurse,  and  the  real  head  of  all  the  female 
staff  of  the  hospital.  Vest  the  whole  responsibility 
for  nursing,  internal  management,  for  discipline  and 
training  of  nurses  in  this  one  female  head  of  the 
nursing  staff,  whatever  called.  She  should  be  herself 
responsible     directly    to    the     constituted     hospital 


266  A  History  of  Nursing 

authorities,  and  all  her  nurses  and  servants  should, 
in  the  performance  of  their  duties,  be  responsible  in 
matters  of  conduct  and  discipline  to  her  only.  No 
good  ever  comes  of  the  constituted  authorities  placing 
themselves  in  the  office  which  they  have  sanctioned 
her  occupying.  No  good  ever  comes  of  any  one  inter- 
fering between  the  head  of  the  nursing  establishment 
and  her  nurses.  It  is  fatal  to  discipline.  Without 
such  discipline,  the  main  object  of  the  whole  hospital 
organisation,  viz.  to  carry  out  effectively  the  orders 
of  the  physicians  and  surgeons  with  regard  to  the 
treatment  of  the  patients,  will  not  be  attained. 

Having  then,  as  a  basis,  a  well  organised  hospital, 
we  require  as  further  conditions: 

(i)  A  special  organisation  for  the  purpose  of  train- 
ing, that  is,  where  systematic  technical  training  is 
given  in  the  wards  to  the  probationers;  where  it  is 
the  business  of  the  ward  "Sisters"  to  train  them,  to 
keep  records  of  their  progress,  to  take  "stock"  of 
them;  where  the  probationers  are  not  set  down  in  the 
wards  to  "pick  up"  as  they  can. 

(2)  A  good  "home"  for  the  probationers  in  the 
hospital,  where  they  learn  moral  discipline — for  tech- 
nical training  is  only  half  the  battle,  perhaps  less 
than  half;  where  the  probationers  are  steadily 
"mothered"  by  a  "home"  Sister  (class  mistress). 

(3)  Staff  of  training  school,  (a)  A  trained  matron 
over  all,  who  is  not  only  a  housekeeper,  but  distinctly 
the  head  and  superintendent  of  the  nursing,  (b)  A 
"home"  Sister  (assistant  superintendent) — making 
the  "home"  a  real  home  to  the  probationers,  giving 
them  classes,  discipHning  their  life,  (c)  Ward  Sisters 
(head  nurses  of  wards)  who  have  been  trained  in  the 
ichool — ^to  a  certain  degree  permanent,  that  is,  not 


Miss  Nightingale's  Writings       267 

constantly  changing.  For  they  are  the  key  to  the 
whole  situation,  the  matron  influencing  through  them 
nurses  (day  and  night),  probationers,  wardmaids, 
patients.  For,  after  all,  the  hospital  is  for  the  good 
of  the  patients,  not  for  the  good  of  the  nurses.  And 
the  patients  are  not  there  to  teach  probationers  upon. 
Rather,  probationers  had  better  not  be  there  at  all 
unless  they  understand  that  they  are  there  for  the 
patients,   and  not   for  themselves. 

There  should  be  an  entente  cordiale  between  matron, 
assistant  matrons,  "home"  Sister,  and  whatever 
other  female  head  there  is,  with  frequent  informal 
meetings,  exchanging  information,  or  there  can  be 
no  unity  in  training. 

Nursing  proper  means,  besides  giving  the  medicines 
and  stimulants  prescribed,  or  the  surgical  appliances, 
the  proper  use  of  fresh  air  (ventilation),  light,  warmth, 
cleanliness,  quiet,  and  the  proper  choosing  and  giving 
of  diet,  all  at  the  least  expense  of  vital  power  to  the 
sick.  And  so  health-at-home  nursing  means  exactly 
the  same  proper  use  of  the  same  natural  elements 
with  as  much  life-giving  power  as  possible  to  the 
healthy. 

We  have  awakened,  though  still  far  from  the  mark, 
to  the  need  of  training  or  teaching  for  nursing  proper. 
But,  while  a  large  part  of  so-called  civilisation  has 
been  advancing  in  direct  opposition  to  the  laws  of 
health,  we  uncivilised  persons,  the  women,  in  whose 
hands  rests  the  health  of  babies,  household  health, 
still  persevere  in  thinking  health  something  that 
grows  of  itself  (as  Topsy  said,  "God  made  me  so  long, 
and  I  grow'd  the  rest  myself"),  while  we  don't  take 
the  same  care  of  human  health  as  we  do  of  that  of 
o\\r  plants,  which,  we  know  very  well,  perish  in  the 


268  A  History  of  Nursing 

rooms,  dark  and  close,  to  which  we  too  often  confine 
human  beings,  especially  in  their  sleeping  rooms  and 
workshops. 

The  life  duration  of  babies  is  the  most  "delicate 
test"  of  health  conditions.  What  is  the  proportion 
of  the  whole  population  of  cities  or  country  which 
dies  before  it  is  five  years  old?  We  have  tons  of 
printed  knowledge  on  the  subject  of  hygiene  and 
sanitation.  The  causes  of  enormous  child  mortality 
are  perfectly  well  known:  they  are  chiefly  want  of 
cleanliness,  want  of  fresh  air,  careless  dieting  and 
clothing,  want  of  whitewashing,  dirty  feather-beds 
and  bedding — in  one  word,  want  of  household  care  of 
health.  The  remedies  are  just  as  well  known,  but 
how  much  of  this  knowledge  has  been  brought  into 
the  homes  and  households  and  habits  of  the  people, 
poor  or  even  rich?  Infection,  germs,  and  the  like 
are  now  held  responsible  as  carriers  of  disease. 
"Mystic  rites,"  such  as  disinfection  and  antiseptics, 
take  the  place  of  sanitary  measures  and  hygiene. 

The  true  criterion  of  ventilation,  for  instance,  is  to 
step  out  of  the  bedroom  or  sick-room  in  the  morning 
into  the  open  air.  If  on  returning  to  it  you  feel 
the  least  sensation  of  closeness,  the  ventilation  has 
not  been  enough,  and  that  room  has  been  unfit  for 
either  sick  or  well  to  sleep  in.  Here  is  the  natural 
test  provided  for  the  evil. 

The  laws  of  God — the  laws  of  life — are  always 
conditional,  always  inexorable.  But  neither  mothers 
nor  school-mistresses,  nor  nurses  of  children  are  prac- 
tically taught  how  to  work  within  those  laws  which 
God  has  assigned  to  the  relations  of  our  bodies  with 
the  world  in  which  He  has  put  them.  In  other  words, 
we  do  not  study,  we  do  not  practise  the  laws  which 


Miss  Nightingale's  Writings        269 

make  these  bodies,  into  which  He  has  put  our 
minds,  healthy  or  unhealthy  organs  of  those  minds: 
we  do  not  practise  how  to  give  our  children  healthy 
existences. 

It  would  be  utterly  unfair  to  lay  all  the  fault  upon 
us  women,  none  upon  the  buildings,  drains,  water- 
supply.  There  are  millions  of  cottages,  more  of 
town  dwellings,  even  of  the  rich,  where  it  is  utterly 
impossible  to  have  fresh  air. 

As  for  the  workshops,  work-people  should  remember 
health  is  their  only  capital,  and  they  should  come 
to  an  understanding  among  themselves  not  only  to 
have  the  means,  but  to  use  the  means  to  secure  pure 
air  in  their  places  of  work,  which  is  one  of  the  prime 
agents  of  health.  This  would  be  worth  a  "trades 
union,"  almost  worth  a  strike. 

And  the  crowded  national  or  board  school — in  it 
how  many  children's  epidemics  have  their  origin!  And 
the  great  school  dormitories!  Scarlet  fever  and 
measles  would  be  no  more  ascribed  to  "current  con- 
tagion," or  to  "something  being  much  about  this 
year,"  but  to  its  right  cause:  nor  would  "plague  and 
pestilence"  be  said  to  be  "in  God's  hands,"  when,  so 
far  as  we  know.  He  has  put  them  into  our  own. 

The  chief  "epidemic"  that  reigns  this  year  is 
"folly."  You  must  form  pubHc  opinion.  The  gen- 
erality of  officials  will  only  do  what  you  make  them. 
You,  the  public,  must  make  them  do  what  you  want. 
But  while  public  opinion,  or  the  voice  of  the  people, 
is  somewhat  awake  to  the  building  and  drainage 
question,  it  is  not  at  all  awake  to  teaching  mothers 
and  girls  practical  hygiene.  Where,  then,  is  the 
remedy  for  this  ignorance? 

Health  in  the  home  can  only  be  learnt  from  the 


2  70  A  History  of  Nursing 

home  and  in  the  home.  Some  eminent  medical  officers, 
referring  to  ambulance  lectures,  nursing  lectures,  the 
fashionable  hygienic  lectures  of  the  day,  have  ex- 
pressed the  opinion  that  we  do  no  more  than  play 
with  our  subject  when  we  "sprinkle"  lectures  over 
the  community,  as  that  kind  of  teaching  is  not  in- 
struction, and  can  never  be  education:  that  as 
medicine  and  surgery  can,  like  nursing,  only  be 
properly  taught  and  properly  learnt  in  the  sick-room 
and  by  the  patient's  side,  so  sanitation  can  only  be 
taught  properly  and  learned  properly  in  the  home 
and  house.  Some  attempts  have  been  made  practi- 
cally to  realise  this,  to  which  subsequent  reference 
will  be  made. 

Wise  men  tell  us  that  it  is  expecting  too  much  to 
suppose  that  we  shall  do  any  real  good  by  giving  a 
course  of  lectures  on  selected  subjects  in  medicine, 
anatomy,  ph3'siology,  and  other  such  cognate  sub- 
jects, all  "watered  down"  to  suit  the  public  palate, 
which  is  really  the  sort  of  thing  one  tries  to  do  in  that 
kind  of  lectures. 

It  is  surely  not  enough  to  say,  "The  people  are 
much  interested  in  the  lecture."  The  point  is, 
Did  they  practise  the  lecture  in  their  own  homes 
afterwards?  did  they  really  apply  themselves  to  the 
household  health  and  the  means  of  improving  it? 
Is  anything  better  worth  practising  for  mothers 
than  the  health  of  their  famiUes? 

The  work  we  are  speaking  of  has  nothing  to  do 
with  nursing  disease,  but  with  maintaining  health 
by  removing  the  things  which  disturb  it,  which  have 
been  summed  up  in  the  population  in  general  as 
**dirt,  drink,  diet,  damp,  draughts,  drains." 

But,  in  fact,  the  people  do  not  believe  in  sanitation 


Miss  Nightingale's  Writings       271 

as  affecting  health,  as  preventing  disease.  They 
think  it  is  a  "fad"  of  the  doctors  and  rich  people. 
They  believe  in  catching  cold  and  in  infection,  catching 
complaints  from  each  other,  but  not  from  foul  earth, 
bad  air,  or  impure  water.  May  not  some  remedy  be 
found  for  these  evils  by  directing  the  attention  of  the 
public  to  the  training  of  health-nurses,  as  has  already 
been  done  with  regard  to  the  training  of  sick-nurses? 

The  scheme  before  referred  to  for  health-at-home 
nursing  has  arisen  in  connection  with  the  newly-con- 
stituted administration  of  counties  in  England,  by 
which  the  local  authority  of  the  county  (County 
Council)  has  been  invested  by  Act  of  Parliament 
with  extended  sources  of  income  applicable  to  the 
teaching  of  nursing  and  sanitary  knowledge,  in 
addition  to  the  powers  which  they  already  possessed 
for  sanitary  inspection  and  the  prevention  of  infectious 
diseases.  This  scheme  is  framed  for  rural  districts, 
but  the  general  principles  are  also  applicable  to  urban 
populations,  though,  where  great  numbers  are  massed 
together,  a  fresh  set  of  difficulties  must  be  met,  and 
different  treatment  be  necessary. 

The  scheme  contemplates  the  training  of  ladies, 
so-called  health  missioners,  so  as  to  qualify  them  to 
give  instruction  to  village  mothers  in:  (i)  The  sani- 
tary condition  of  the  person,  clothes  and  bedding,  and 
house.  (2)  The  management  of  health  of  adults, 
women  before  and  after  confinement,  infants  and 
children.  The  teaching  by  the  health  missioners 
would  be  given  by  lectures  in  the  villages,  followed 
by  personal  instruction  by  way  of  conversation  with 
the  mothers  in  their  own  homes,  and  would  be  di- 
rected to:  (i)  The  condition  of  the  homes  them- 
selves in  a  sanitary  point  of  view;  (2)  the  essential 


2  72  A  History  of  Nursing 

principles  of  keeping  the  body  in  health,  with  refer- 
ence to  the  skin,  the  circulation,  and  the  digestion; 
and  (3)  instruction  as  to  what  to  do  in  cases  of  emer- 
gency or  accident  before  the  doctor  comes,  and  with 
reference  to  the  management  of  infants  and  children. 
In  the  addendum  to  this  paper  will  be  found  a  scheme 
for  training  health- at- home  missioners,  a  syllabus  of 
lectures  given  by  the  medical  officer  to  the  health 
missioners,  and  a  syllabus  of  health  lectures  given  by 
the  health  missioners  to  village  mothers. 

IV.  Dangers.  After  only  a  generation  of  nursing 
arise  the  dangers:  (i)  Fashion  on  the  one  side,  and 
its  consequent  want  of  earnestness.  (2)  Mere  money- 
getting  on  the  other.  Woman  does  not  live  by  wages 
alone.  (3)  Making  nursing  a  profession,  and  not  a 
calling. 

What  is  it  to  feel  a  calling  for  an}i:hing?  Is  it  not 
to  do  our  work  in  it  to  satisf}'  the  high  idea  of  what 
is  the  right,  the  best,  and  not  because  we  shall  be 
found  out  if  we  don't  do  it  ?  This  is  the  "enthusiasm *' 
which  every  one,  from  a  shoemaker  to  a  sculptor, 
must  have  in  order  to  follow  his  "calling"  properly. 
Now,  the  nurse  has  to  do  not  with  shoes  or  with 
marble,  but  with  living  human  beings. 

How,  then,  to  keep  up  the  high  tone  of  a  calling,  to 
*'make  your  calling  and  election  sure  "?  By  fostering 
that  bond  of  sympathy  {esprit  de  corps)  which  com- 
munity of  aims  and  of  action  in  good  work  induces; 
a  common  nursing  home  in  the  hospital  for  hospital 
nurses  and  for  probationer  nurses;  a  common  home 
for  private  nurses  during  intervals  of  engagements, 
whether  attached  to  a  hospital,  or  separate;  a  home 
for  district  nurses  (wherever  possible),  where  four  or 
five  can  live  together :  all  homes  under  loving,  trained, 


Miss  Nightingale's  Writings      273 

moral,  and  religious,  as  well  as  technical  superintend- 
ence, such  as  to  keep  up  the  tone  of  the  inmates  with 
constant  supply  of  all  material  wants  and  constant 
sympathy.  Man  cannot  live  by  bread  alone,  still  less 
woman.  Wages  is  not  the  only  question,  but  high 
home-helps. 

The  want  of  these  is  more  especially  felt  among  pri- 
vate nurses.  The  development  in  recent  years  of 
trained  private  nursing,  i.  e.,  of  nursing  one  sick  or 
injured  person  at  a  time  at  home,  is  astonishing.  But 
not  less  astonishing  the  want  of  knowledge  of  what 
training  is,  and,  indeed,  of  what  w^oman  is.  The  dan- 
ger is  that  the  private  nurse  may  become  an  irresponsi- 
ble nomad.  She  has  no  home.  There  can  be  no 
esprit  de  corps  if  the  "corps"  is  an  indistinguishable 
mass  of  hundreds,  perhaps  thousands,  of  women  un- 
known to  her,  except,  perhaps,  by  a  name  in  a  register. 
All  community  of  feeling  and  higher  tone  absents 
itself.  And  too  often  the  only  aim  left  is  to  force  up 
wages.  Absence  of  the  nursing  home  is  almost  fatal 
to  keeping  up  to  the  mark.  Night  nurses  even  in 
hospitals,  and  even  district  nurses  (another  branch 
of  trained  nursing  of  the  sick  poor  without  almsgiving 
which  has  developed  recently),  and  above  all  private 
nurses,  deteriorate  if  they  have  no  esprit  de  corps,  no 
common  home  under  w^ise  and  loving  supervision  for 
intervals  between  engagements.  What  they  can  get 
in  holidays,  in  comforts,  in  money,  these  good  women 
say  themselves,  is  an  increasing  danger  to  many.  In 
private  nursing  the  nurse  is  sometimes  spoilt,  some- 
times "  put  upon,"  sometimes  both. 

In  the  last  few  years,  private  trained  nursing,  dis- 
trict trained  nursing,  have,  as  has  been  said,  gained 
immeasurably  in  importance,  and  with  it  how  to  train, 

VOL.  II. — 18. 


274  A  History  of  Nursing 

how  to  govern  (in  the  sense  of  keeping  up  to  the  high- 
est attainable  in  tone  and  character,  as  well  as  in 
technical  training),  must  gain  also  immeasurably  in 
importance,  must  constitute  almost  a  new  starting- 
point.  Nursing  may  cease  to  be  a  calling  in  any  bet- 
ter sense  than  millinery  is.  To  have  a  life  of  freedom, 
with  an  interesting  employment,  for  a  few  years — to 
do  as  little  as  you  can  and  amuse  yourself  as  much  as 
you  can — is  possibly  a  danger  pressing  on. 

(4)  There  is  another  danger,  perhaps  the  greatest 
of  all.  It  is  also  a  danger  which  grows  day  by  day. 
It  is  this ;  as  literary  education  and  colleges  for  women 
to  teach  literary  work  start  and  multiply  and  improve, 
some,  even  of  the  very  best  women,  believe  that  every- 
thing can  be  taught  by  book  and  lecture, ^  and  tested 
by  examination — that  memory  is  the  great  step  to 
excellence. 

Can  you  teach  horticulture  or  agriculture  by  books, 
e.g.,  describing  the  different  manures,  artificial  and 
natural,  and  their  purposes?  The  being  able  to  know 
every  clod,  and  adapt  the  appropriate  manure  to  it, 
is  the  real  thing.  Could  you  teach  painting  by  giving, 
e,  g,  Fuseli's  lectures?  Fuseli  himself  said,  when  asked 
how  he  mixed  his  colours,  "With  brains,  sir" — that 
is,  practice  guided  by  brains.  But  you  have  another, 
a  quite  other  sort  of  a  thing  to  do  with  nursing:  for 
you  have  to  do  with  living  bodies  and  living  minds, 
and  feelings  of  both  body  and  mind. 

It  is  said  that  you  give  examinations  and  certificates 
to  plumbers,  engineers,  etc.  But  it  is  impossible  to 
compare  nurses  with  plumbers,  or  carpenters,  or  en- 

iMiss  Nightingale  is  greatly  mistaken  in  this  statement. 
Instead  of  "women"  she  should  have  said  "men,"  though 
they  are  not  the  best. 


Miss  Nightingale's  Writings       275 

gineers,  or  even  with  gardeners.  The  main,  the  tre- 
mendous difference  is  that  nurses  have  to  do  with  these 
living  bodies  and  no  less  living  minds:  for  the  life  is 
not  vegetable  life,  nor  mere  animal  life,  but  it  is  human 
life — with  living,  that  is,  conscious  forces,  not  electric 
or  gravitation  forces,  but  human  forces.  If  you 
examine  at  all,  you  must  examine  all  day  long,  current 
examination,  current  supervision,  as  to  what  the  nurse 
is  doing  with  this  double,  this  damaged  life  entrusted 
to  ker. 

The  physician  or  surgeon  gives  his  orders,  generally 
his  conditional  orders,  perhaps  once  or  twice  a  day, 
perhaps  not  even  that.  The  nurse  has  to  carry  them 
out,  with  intelligence  of  conditions,  every  minute  of 
the  twenty- four  hours. 

The  nurse  must  have  method,  self-sacrifice,  watch- 
ful activity,  love  of  the  work,  devotion  to  duty  (that 
:.s,  the  service  of  the  good),  the  courage,  the  coolness 
of  the  soldier,  the  tenderness  of  the  mother,  the  ab- 
sence of  the  prig  (that  is,  never  thinking  that  she  has 
attained  perfection  or  that  there  is  nothing  better). 
She  must  have  a  threefold  interest  in  her  work — an 
intellectual  interest  in  the  case,  a  (much  higher) 
hearty  interest  in  the  patient,  a  technical  (practical) 
interest  in  the  patient's  care  and  cure.  She  must  not 
look  upon  patients  as  made  for  nurses,  but  upon 
niu-ses  as  made  for  patients. 

There  may  also  now — I  only  say  may — with  all  this 
dependence  on  literary  lore  in  nurse  training,  be 
a  real  danger  of  being  satisfied  with  diagnosis,  or 
with  looking  too  much  at  the  pathology  of  the  case, 
without  cultivating  the  resource  or  intelligence  for  the 
thousand  and  one  means  of  mitigation,  even  where 
there  is  no  cure. 


276  A  History  of  Nursing 

And  never,  never  let  the  nurse  forget  that  she  must 
look  for  the  fault  of  the  nursing,  as  much  as  for  the 
fault  of  the  disease,  in  the  symptoms  of  the  patient. 

(5)  Forty  or  fifty  years  ago  a  hospital  was  looked 
upon  as  a  box  to  hold  patients  in.  The  first  question 
never  was,  Will  the  hospital  do  them  no  harm?  Enor- 
mous strides  have  had  to  be  made  to  build  and  arrange 
hospitals  so  as  to  do  the  patients  no  sanitary  or  insani- 
tary harm.  Now  there  is  danger  of  a  hospital  being 
looked  upon  as  a  box  to  train  nurses  in.  Enormous 
strides  must  be  made  not  to  do  them  harm,  to  give 
them  something  that  can  really  be  called  an  "all- 
around"  training. 

Can  it  be  possible  that  a  testimonial  or  certificate, 
of  three  years'  so-called  training  or  service  from  a 
hospital — any  hospital  with  a  certain  number  of  beds 
■ — can  be  accepted  as  sufficient  to  certify  a  nurse  for  a 
place  in  a  public  register?  As  well  might  we  not  take 
a  certificate  from  any  garden  of  a  certain  number  of 
acres,  that  plants  are  certified  valuable  if  they  have 
been  three  years  in  the  garden  ? 

(6)  Another  danger — that  is,  stereotyping,  not 
progressing.  **No  system  can  endure  that  does  not 
march."  Are  we  walking  to  the  future  or  to  the  past? 
Are  we  progressing  or  are  we  stereotyping?  We  re- 
member that  we  have  scarcely  crossed  the  threshold 
of  uncivilised  civilisation  in  nursing:  there  is  still  so 
much  to  do.     Don't  let  us  stereotype  mediocrity. 

To  sum  up  the  dangers; 

I.  On  one  side,  fashion,  and  want  of  earnestness, 
not  making  it  a  life,  but  a  mere  interest  consequent  on 
this, 

II.  On  the  other  side,  mere  money-getting:  yet 
man  does  not  live  by  bread  alone,  still  less  woman. 


Miss  Nightingale's  Writings       277 

III.  Making  it  a  profession,  and  not  a  calling.  Not 
making  your  "calling  and  election  sure";  wanting, 
especially  with  private  nurses,  the  community  of  feel- 
ing of  a  common  nursing  home,^  pressing  towards  the 
"mark  of  your  calling,"  keeping  up  the  moral  tone. 

IV.  Above  all,  danger  of  making  it  book-learn- 
ing and  lectures — not  an  apprenticeship,  a  workshop 
practice. 

V.  Thinking  that  any  hospital  with  a  certain  num- 
ber of  beds  may  be  a  box  to  train  nurses  in,  regardless 
of  the  conditions  essential  to  a  sound  hospital  organ- 
isation, especially  the  responsibility  of  the  female 
head  for  the  conduct  and  discipline  of  the  nurses. 

VI.  Imminent  danger  of  stereotyping  instead  of 
progressing.  "No  system  can  endure  that  does  not 
march."  Objects  of  registration  not  capable  of  being 
gained  by  a  public  register.  Who  is  to  guarantee 
our  guarantors?  Who  is  to  make  the  inquiries?  You 
might  as  well  register  mothers  as  nurses,  A  good 
nurse  must  be  a  good  woman. 

V.  The  health  of  the  unity  is  the  health  of  the 
community.  Unless  you  have  the  health  of  the  unity 
there  is  no  community  health. 

Competition,  or  each  man  for  himself,  and  the  devil 
against  us  all,  may  be  necessary,  we  are  told,  but  it  is 
the  enemy  of  health.  Combination  is  the  antidote — 
combined  interests,  recreation,  combination  to  secure 
the  best  air,  the  best  food,  and  all  that  makes  life  use- 
ful, healthy,  and  happy.     There  is  no  such  thing  as 

>  In  the  United  States  it  is  probable  that  private  nurses  are 
of  higher  education  than  in  England.  On  the  other  hand, 
they  have  the  doubtful  dignity  of  graduates. 


278  A  History  of  Nursing 

independence.  As  far  as  we  are  successful,  our  success 
lies  in  combination. 

The  Chicago  Exhibition  is  a  great  combination 
from  all  parts  of  the  world  to  prove  the  dependence 
of  man  on  man. 

What  a  lesson  in  combination  the  United  States 
have  taught  to  the  w^hole  world,  and  are  teaching! 

In  all  departments  of  life  there  is  no  apprenticeship 
except  in  the  workshop.  No  theories,  no  book-learn- 
ing can  ever  dispense  with  this  or  be  useful  for  any- 
thing, except  as  a  stepping-stone.  And  rather  more 
than  for  anything  else  is  this  true  for  health.  Book- 
learning  is  useful  only  to  render  the  practical  health 
of  the  health-workshop  intelligent,  so  that  every 
stroke  of  work  done  there  should  be  felt  to  be  an  illus- 
tration of  what  has  been  learned  elsewhere — a  driving 
home,  by  an  experience  not  to  be  forgotten,  what  has 
been  gained  by  knowledge  too  easily  forgotten. 

Look  for  the  ideal,  but  put  it  into  the  actual — "not 
by  vague  exhortations,  but  by  striving  to  turn  beliefs 
into  energies  that  would  work  in  all  the  details"  of 
health.  The  superstitions  of  centuries,  the  bad  hab- 
its of  generations,  cannot  be  cured  by  lecture,  book,  or 
examination. 

VI.  May  our  hopes  be  that,  as  every  year  the  tech- 
nical qualifications  constituting  a  skilful  and  observ- 
ing nurse  meet  with  more  demands  on  her  from  the 
physicians  and  surgeons,  progress  may  be  made  year 
by  year,  and  that  not  only  in  technical  things,  but  in 
the  qualifications  which  constitute  a  good  and  trust- 
worthy woman,  without  which  she  cannot  be  a  good 
nurse.  Examination  papers,  examinations,  public  reg- 
istration, graduation,  form  little  or  no  test  of  these 


Miss  Nightingale's  Writings      279 

qualifications.  The  least  educated  governess,  who 
may  not  be  a  good  nurse  at  all,  may,  and  probably 
will,  come  off  best  in  examination  papers,  while  the 
best  nurse  may  come  off  worst.  May  we  hope  that 
the  nurse  may  understand  more  and  more  of  the  moral 
and  material  government  of  the  world  by  the  Supreme 
Moral  Governor,  higher,  better,  holier  than  her  "own 
acts,"  that  government  which  enwraps  her  round, 
and  by  which  her  own  acts  must  be  led,  with  which 
her  own  acts  must  agree  in  their  due  proportion  in 
order  that  this,  the  highest  hope  of  all,  may  be  hers; 
raising  her  above,  i.  e.,  putting  beneath  her,  dangers, 
fashions,  mere  money-getting,  solitary  money-getting, 
but  availing  herself  of  the  high  helps  that  may  be 
given  her  by  the  sympathy  and  support  of  good 
"homes";  raising  her  above  intrusive  personal  morti- 
fications, pride  in  her  own  proficiency  (she  may  have 
a  just  pride  in  her  own  doctors  and  training  school), 
sham,  and  clap-trap;  raising  her  to  the  highest 
"grade  "  of  all,  to  be  a  fellow- worker  with  the  Supreme 
Good,  with  God!  That  she  may  be  a  "graduate"  in 
this,  how  high!  that  she  may  be  a  "graduate"  in 
words,  not  realities,  how  low! 

We  are  only  on  the  threshold  of  nursing. 

In  the  future,  which  I  shall  not  see,  for  I  am  old, 
may  a  better  way  be  opened!  May  the  methods  by 
which  every  infant,  every  human  being,  will  have  the 
best  chance  of  health,  the  me  hods  by  which  every 
sick  person  will  have  the  best  chance  of  recovery,  be 
learned  and  practised!  Hospitals  are  only  an  inter- 
mediate stage  of  civilisation,  never  intended,  at  all 
events,  to  take  in  the  whole  sick  population. 

May  we  hope  that  the  day  will  come  when  every 
mother  will  become  a  health-nurse,  when  every  poor 


28o  A  History  of  Nursing 

sick  person  will  have  the  opportunity  of  a  share  in  a 
district  sick-nurse  at  home!  But  it  will  not  be  out  of 
a  register :  the  nurse  w  11  not  be  a  stereotyped  one. 
We  find  a  trace  of  nursing  here,  another  there;  we 
find  nothing  like  a  nation,  or  race,  or  class  who  know 
how  to  provide  the  elementary  conditions  demanded 
for  the  recovery  of  their  sick,  whose  mothers  know 
how  to  bring  up  their  infants  for  health. 

May  we  hope  that  when  we  are  all  dead  and  gone 
leaders  will  arise  who  have  been  personally  experi- 
enced in  the  hard,  practical  work,  the  difficulties  and 
the  joys  of  organising  nursing  reforms,  and  who  will 
lead  far  beyond  anything  we  have  done!  May  we 
hope  that  every  nurse  will  be  an  atom  in  the  hierarchy 
of  the  ministers  of  the  Highest !  But  then  she  must  be 
in  her  place  in  the  hierarchy,  not  alone,  not  an  atom 
in  the  indistinguishab  e  mass  of  the  thousands  of 
nurses.     High  hopes,  which  will  not  be  deceived ! 

Aside  from  nursing  proper  ]\Iiss  Nightingale's 
sympathetic  interest  and  the  magic  power  of  her 
name  have  been  given  to  innumerable  causes  and 
campaigns  of  right  against  wrong.  Among  such 
we  may  instance  especially  the  long  struggle  made 
by  a  few  heroic  women  (finally  successful)  for  the 
repeal  of  odious  laws  regarding  the  regulation  of 
vice  in  England.  ]\Iiss  Nightingale's  name  w^as 
placed  on  a  petition  for  repeal.  She  has  also 
always  held  broad  impersonal  views  on  the  sub- 
ject of  public  service.  An  illustration  of  this  atti- 
tude is  given  by  some  of  her  words  in  Notes  on 
Nursing. 

I  would  earnestly  ask  my  sisters  to  keep  clear  of 


Miss  Nightingale's  Writings       281 

both  the  jargons  now  current  everywhere  (for  they 
are  equally  jargons) :  of  the  jargon,  namely,  about 
the  "rights"  of  women,  which  urges  women  to  do  all 
that  men  do,  including  the  medical  and  other  profes- 
sions, merely  because  men  do  it,  and  without  regard 
to  whether  this  is  the  best  that  women  can  do ;  and  of 
the  jargon  which  urges  women  to  do  nothing  that 
men  do,  merely  because  they  are  women,  and  should 
be  "recalled  to  a  sense  of  their  duty  as  women,"  and 
because  "this  is  women's  work,"  and  "that  is  men's," 
and  "these  are  things  which  women  should  not  do," 
which  is  all  assertion,  and  nothing  more.  Surely 
woman  should  bring  the  best  she  has,  whatever  that 
is,  to  the  work  of  God's  world,  without  attending  to 
either  of  these  cries.  .  .  .  But  you  want  to  do  the 
thing  that  is  good,  whether  it  is  "suitable  for  a  wo- 
man" or  not. 

It  does  not  make  a  thing  good  that  it  is  remarkable 
that  a  woman  should  have  been  able  to  do  it.  Neither 
does  it  make  a  thing  bad,  which  would  have  been  good 
had  a  man  done  it,  that  it  has  been  done  by  a  woman. 

Oh,  leave  these  jargons,  and  go  your  way  straight 
to  God's  work,  in  simplicity  and  singleness  of  heart.* 

She  has  been  a  life-long  advocate  of  suffrage 
for  women,  says  the  Woman's  Journal,  and  when 
asked  one  time  for  her  reasons,  said : 

I  have  no  reasons.  It  seems  to  me  almost  self- 
evident,  an  axiom,  that  every  householder  and  tax- 
payer should  have  a  voice  in  the  expenditure  of  the 
money  we  pay,  including,  as  this  does,  interests  the 
most  vital  to  a  human  being. 

1  Notes,  p.  135. 


282  A  History  of  Nursing 

An  interesting  testimony  to  her  constant  inter- 
est in  and  attention  to  progressive  social  steps  was 
a  letter  written  by  her  in  1892,  to  a  public  official, 
in  which  she  said : 

We  must  create  a  public  opinion  which  will  drive 
the  Government,  instead  of  the  Government  having 
to  drive  us — an  enlightened  public  opinion,  wise  in 
principles,  wise  in  details.  We  hail  the  County  Coun- 
cil as  being  or  becoming  one  of  the  strongest  engines 
in  our  favour,  at  once  fathering  and  obeying  the  great 
impulse  for  national  health  against  national  and  local 
disease.  For  we  have  learned  that  we  have  national 
health  in  our  own  hand — local  sanitation,  national 
health.  But  we  have  to  contend  against  centuries  of 
superstition  and  generations  of  indifference." 

One  of  the  most  interesting  published  expres- 
sions of  her  views  on  social  questions,  showing,  as 
it  does,  that  from  her  sick-room  she  constantly 
w4th  eager  hope  followed  the  tendencies  of  political 
and  voluntary  social  action,  is  an  article  written 
in  1873: 

What  will  this  world  be  in  August,  1999  .  .  . 
what  shall  we  wish  then  to  have  been  doing,  and  what 
shall  we  wish  not  to  have  been  doing  ?  .  .  .  Will  the 
views  of  family  life,  of  social  Hfe,  of  the  duties  of  social 
life,  be  the  same  then  as  now?  Will  the  distribution 
of  riches,  of  poverty,  of  the  land  ...  be  the  same 
then  as  now?  Will  religion  consist  then,  as  now,  not 
in  whether  a  man  is  "just,  true  and  merciful"  .  .  . 
but  whether  the  man  "had  believ^ed  what  he  was  told 
to  beUeve"    .    .    .     What  shall  we  then  wish  to  have 


Miss  Nightingale's  Writings      283 

been  doing  now?  Is  it  reading  or  writing  mere  arti- 
cles? ...  or  is  it  working,  solving  by  real  personal 
work  the  great  questions,  or  rather  problems,  which, 
as  they  are  solved  or  unsolved,  will  make  1999  what 
it  will  be? — such  as  depauperisation,  colonisation, 
education,  reformation,  legislation,  making  religion 
and  God  a  real  personal  presence  among  us,  not  a 
belief  in  a  creed,  a  going  to  a  room  or  church,  "for 
what  we  call  our  prayers." 

In  this  article  all  of  her  life-long  elemental,  fer- 
vent hatred  of  sham  and  conventional  lies  breaks 
forth  again :  it  is  an  expression  of  revolt — of  rejec- 
tion of  current  smugness  of  thought. 

Religion,  sermons,  consist  now  either  in  telling  us 
to  believe  what  we  are  "  told  to  believe,"  and  to  attend 
the  "means  of  grace" — never  enquiring  whether 
there  be  not  other  "means  of  grace,"  or  else,  in 
telling  us  to  practise  certain  so-called  religious  or 
social  virtues  in  that  "  state  of  life"  (or  state  of  mind) 
"to  which  it  has  been  pleased  to  call  us,"  leaving  Hfe 
just  as  it  is,  taking  for  granted  that  that  "  state  of  life  " 
is  the  one  we  are  born  into. 

But,  in  1999,  shall  we  not  wish  to  have  worked  out 
what  life,  family  life,  social  life,  political  life,  should 
be,  and  not  to  have  taken  for  granted  that  family 
life,  social  life,  political  life,  are  to  be  as  they  are,  and 
we  to  get  as  much  enjoyment  out  of  them  as  we  can? 

...  It  never  seems  to  be  thought  that  it  is  more 
difficult  to  discover  the  ways  of  creating  the  kingdom 
of  heaven  upon  earth  than  to  discover  the  ways  of 
the  solar  system — yet  no  one  would  ever  think  of 
recommending  the  study  of  astronomy  to  be  pursued 


284  A  History  of  Nursing 

in  the  weak,  pretentious,  sententious  manner  that  we 
are  preached  to  about  pursuing  Life.  Yet  life  is  a 
harder  study  than  astronomy,  if  we  are  really  to  suc- 
ceed in  it,  really  to  succeed  in  bringing  about  a  little 
comer  of  the  kingdom  of  heaven. 

We  are  never  lectured  about  the  study  of  anything 
else  in  the  wild,  wishy-washy,  womanish  terms  that 
we  are  preached  to  about  life.  And  this  is  thought 
Christian — as  if  Christ  had  not  been  the  boldest 
preacher  that  ever  went  about  reforming  life.  .  .  . 

In  a  new  and  striking  form  she  re-embodies  her 
life-long  insistence  on  thorough  preparation  as 
necessary  for  efficiency : 

Freedom  is  indeed  not  doing  as  we  like,  not  every- 
body following  his  or  her  own  way,  even  if  that  were 
possible,  but  self-control.  Self-control,  plus  a  con- 
trol or  command  of  our  subject,  gives  "freedom";  but 
a  person  who  has  no  control  over  any  subject,  or  right 
use  of  any  faculties,  cannot  have  freedom.  It  all  comes 
to  the  same  thing,  viz.,  the  necessity  of  doing  what 
we  do  well,  of  what  we  do  being  what  is  well  to  do,  if 
we  are  to  attain  what  is  commonly  called  "humility" 
(disregard  of  self,  useful  care  for  others,  efficient  ser- 
vice of  God  and  of  our  brethren). 

The  work  of  iVmold  Toynbee  had  evidently 
aroused  her  keenest  sympathy.  She  alludes  to 
his  work,  without  mentioning  him  by  name,  and 
urges  the  need  of  social  workers ; 

The  kingdom  of  heaven  is  within,  but  no  one 
laboured  like  Christ  to  make  it  without.  He  actually 
recommended  people  to  leave  their  own  lives  to  do 


Miss  Nightingale's  Writings      285 

this,  so  much  was  he  penetrated  by  the  conviction, 
filled  by  the  enthusiasm,  that  we  must  alter  the  "state 
of  life"  {not  conform  to  it,  no,  oh  thrice,  ten  times,  no! 
a  hundred  times,  no!)  into  which  we  are  born,  in  order 
to  bring  about  a  "kingdom  of  heaven."  Never  was 
anything  less  like  remaining  within  good  intentions 
than  Christ's  teaching,  than  Christ's  example.  .  .  .  We 
must  go  forth  into  the  world  to  bring  about  the  king- 
dom of  heaven.  ...  If  we  did  the  things  people  now 
prate  about,  write  about,  speechify,  debate,  report 
about,  that  would  be — Administration. 

She  closes  with  some  of  her  own  inimitable 
aphorisms — keen-edged  as  a  surgeon's  knife.  She 
comments  on  the  w^idespread  epidemic  of  fruitless 
talk  and  compares  the  common  tendency  to  over- 
look the  most  real  and  necessary  for  the  less 
important  to  the  words  of  a  famous  surgeon,  who 
said  of  a  patient  on  whom  a  notable  operation  had 
been  performed,  ''He  died  cured.''' 

Discussion  nowadays  almost  precludes  considera- 
tion— it  leaves  no  time  for  thought.  .  .  .  The  only 
discussion  that  can  be  of  any  use  is  that  between  per- 
sons who  have  thought  out  something  about  the 
subject,  who  bring  some  contribution  of  individual 
thought  or  of  personal  knowledge  to  the  common 
stock.  What  a  valuable  rule  it  would  be,  for  every 
half  hour  spent  in  discussion  spend  two  previous  half 
hours  in  thought ! 

Discussion  will  not  govern  the  world,  nor  even  a 
single  home  in  it. 

Language,  says  Talleyrand,  was  given  us  to  conceal 
our  thoughts.     Even  that  is  better  than  what  we  see 


286  A  History  of  Nursing 

now,  when  language  seems  to  be  given  us  to  conceal 
our  want  of  thoughts.  ^ 

To  sum  up  such  a  character  as  Miss  Nightin- 
gale's, as  displayed  in  her  writings,  in  scattered 
personal  testimony,  and  in  the  multiplied  proofs 
of  her  energising  influence  on  others,  is  a  task 
worthy  of  more  able  minds  than  any  that  have 
yet  attempted  it.  So  rich  a  combination  as  hers 
has  rarely  been  found  of  dominant,  masterful 
intellectual  genius,  of  creative  thought,  of  indi- 
vidual executive  ability  to  transform  thought  into 
effective  action,  while  health  lasted,  and,  when 
health  vanished,  still  to  effect  this  transformation 
through  a  rare  force  of  influence  on  others;  of 
maternal  tenderness  for  all  helpless  and  suffering 
life,  of  cosmopolitan  sympathies  and  diverse 
interests,  of  a  glorious  capacity  for  righteous 
anger,  with  kindliness,  and  forgetfulness  of  self; 
of  free,  fearless  opinions.  These  characteristics 
suggest  a  personality  of  rare  proportions,  for  whose 
heroic  lines  her  keen  satirical  wit,  her  severity  of 
judgment  of  incapacity  and  futility,  her  intoler- 
ance of  mediocrity  and  commonplaceness  form 
only  the  needed  shade  and  colouring.^ 

»  A  Sub-' Note  of  Interrogation,'  by  Florence  Nightingale, 
Eraser's  Magazine,  July,  1873. 

2  Dr.  Abraham  Jacobi  has  characterised  her  as  one  "who 
has  proved  how  to  become  immortal  without  enjoying  high 
office,  or  playing  on  a  cannon,  or  tyrannising  nations,  or 
being  born  on  a  throne." 


CHAPTER  VI. 

MISS  nightingale's  co-workers. 

THE  most  piteous  of  the  caravansaries  for  the 
sick,  and  the  very  last  to  be  cared  for,  were 
the  infirmary  wards  of  the  great  workhouses  or 
almshouses.  These,  the  last  refuge  of  the  incurable 
and  chronic  poor,  beyond  which  no  further  trans- 
fer was  possible  save  into  the  grave,  appear  to  have 
been  left  quite  without  the  pale  of  human  pity  or 
even  interest  until  as  late  as  the  middle  of  the 
nineteenth  century,  when  a  small  group  of  women, 
chief  and  most  untiring  among  whom  was  Miss 
Louisa  Twining,  began  a  veritable  siege  to  break 
down  the  walls  of  official  callousness  and  ignorance 
behind  which  the  dependent  poor  were  virtually 
imprisoned.  This  siege  has  lasted  throughout  the 
half -century,  for  Miss  Twining  still  lives,  with 
the  happiness  of  knowing  that  the  battle  has 
been  won,  though  final  outposts  of  stupidity  still 
remain  to  be  taken. 

The  whole  story  of  these  women's  persistent 
and  undiscouraged  efforts — of  the  obstacles  placed 
in  their  way ;  of  the  rebuffs  which  a  jealous  official- 
dom, fearing  the  light  of  public  inquiry  and  resent- 

287 


288  A  History  of  Nursing 

ing  criticism,  offered  them;  of  their  long,  slow, 
patiently-striven-for  gains  and  advances,  resulting 
in  the  gradual  separation  of  the  sick  from  the 
other  dependents  and  in  the  introduction  of  en- 
lightened methods  of  caring  for  all  classes  of  de- 
pendents— is  a  most  impressive  one,  and  it  is  safe 
to  say  that,  had  it  been  a  campaign  of  war  between 
nations,  it  would  have  been  found  worthy  of  vol- 
umes upon  volumes  of  description. 

Miss  Twining 's  work  has  gone  side  by  side  and 
hand  in  hand  with  the  reform  of  nursing,  and  to- 
day, though  there  is  still  much  to  be  done,  a  mar- 
vellous change  has  taken  place  in  the  workhouses, 
many  of  which  now  have  hospitals  and  trained 
nursing  of  distinguished  excellence. 

]\Iiss  Twining  began  visiting  the  workhouses  in 
1853.  She  first  went  to  see  an  old  woman  whom 
she  had  known  at  home,  and  from  this  circum- 
stance may  be  said  to  date  the  beginning  of  all 
systematic  effort  for  the  organised  visiting  of  work- 
houses both  in  London  and  in  the  country.' 

A  few  years  later,  Miss  Elliott  and  Miss  Frances 
Power  Cobbe  also  becoming  deeply  interested  in 
the  problem  of  the  incurably  ill  poor,  indepen- 
dently, at  first,  of  Miss  Twining's  work,  did  much 
to  stir  popular  sympathy  by  issuing  (in  1861)  the 
first  published  articles  advocating  the  separation 
of  incurable  and  chronic  patients  from  the  ordi- 

'  Recollections  of  Workhouse  Visiting  and  Managing  dur- 
ing Twenty-five  Years,  by  Louisa  Twining.  Kegan  Paul  &  Co., 
London,  1880,  p.  6. 


Miss  Nightingale's  Co-Workers     289 

nary  workhouse  population,  and  urging,  further, 
that  official  permission  should  be  given  for  private 
philanthropy  to  introduce  little  comforts  and 
pleasures  for  the  sick;  for,  incredible  as  it  may 
seem,  this  simple  effort  of  good- will,  when  tried  by 
individuals,  met  with  suspicion  and  peremptory 
refusals  from  the  officials  in  charge  of  workhouses. 
Miss  Elliott  and  Miss  Cobbe  together  wrote  a  cir- 
cular letter  embodying  these  propositions,  and 
sent  it  to  some  six  hundred  and  sixty  Unions 
(guardians  of  the  poor) ,  and  through  their  efforts 
the  Association  for  the  Promotion  of  Social  Science 
which  had  been  founded  in  1856  was  enlisted  in 
the  cause  of  workhouse  reform.  ^ 

That  was  a  time  when  the  most  ordinary  prompt- 
ings of  common-sense  and  humanity  were  regarded 
in  some  quarters  as  visionary,  for  Miss  Cobbe 
(who  tells  many  ludicrous  and  humorous  tales) 
recalls  a  dictum  of  the  Morning  Post,  whose  editor 
regarded  one  of  the  ablest  men  in  England  as 
unquestionably  "cracked"  because  he  believed 
that  it  was  possible  to  reform  juvenile  criminals. ^ 

The  wretched  system  of  nursing  by  drunken 
and  degraded  paupers,  then  prevalent,  was  stead- 
ily assailed  by  all  these  women.  Miss  Cobbe 
speaks  of  the  "monster  evil  of  the  unqualified 
nurse,"  and  concentrated  her  interest  upon  this 
special  department. 

>  Life  of  Frances  Power  Cobbe,  as  told  by  Herself.  Swan 
Sonnenschein,  London,  1904,  p.  315. 

2  "  Social  Science  Congresses  and  Women's  Part  in  Them," 
by  Frances  Power  Cobbe,  Macmillan's  Magazine,  1861. 

VOL.   II. IQ. 


290  A  History  of  Nursing 

She  and  Miss  Elliott  wrote  the  pamphlets 
The  Workhouse  as  a  Hospital,  Destitute  Incura- 
bles, The  Sick  in  Workhouses,  etc.  As  time 
went  on  Miss  Cobbe  became  absorbed  in  other 
interests,  w^hile  Miss  Twining,  who  from  the  first 
had  applied  herself  to  no  less  a  purpose  than  that 
of  revolutionising  the  entire  workhouse  system, 
made  the  nursing  side  one  of  her  reforms,  but  not 
the  only  one.  In  following  out  her  entire  pro- 
gramme she  did  much  to  induce  a  better  class  of 
women  to  take  up  nursing.  Her  pamphlet  Nurs- 
ing for  the  Sick,  with  a  Letter  to  Young  Women, 
London,  1861,  is  a  stirring  appeal  to  the  latent 
tenderness  of  human  nature  and  gives  a  pitiful 
picture  of  the  dreadful  conditions  in  the  work- 
houses. 

What  some  of  these  conditions  were  may  be 
gathered  from  official  reports.  In  1865  a  report 
of  the  Poor  Law  Board  printed  for  the  House  of 
Commons  showed  6400  sick  in  forty-one  London 
workhouses,  of  whom  one  third  were  patients  suf- 
fering from  acute,  curable  diseases.  To  this  mass 
of  patients  there  were  seventy-one  paid  nurses 
(and  it  must  be  remembered  that  even  these  were 
of  the  Gamp  class) ,  some  workhouses  having  only 
one  nurse  apiece.  Thirteen  of  these  institutions 
had  no  paid  nurses  at  all,  but  only  pauper  helpers, 
many  of  whom  were  over  seventy  and  even  eighty 
years  of  age,  while  a  full  one  fourth  were  over 
sixty.  Nor  did  the  term  " paid  nurse"  mean  any- 
thing very  desirable  from  the  labour  standpoint 


Miss  Nightingale's  Co-Workers    291 

Some  of  these  nurses  were  paid  the  lavish  sum  of 
one  penny  per  week,  while  others  received  extra 
diet,  or  clothing,  as  payment.  The  medical  offi- 
cers, who  sometimes  had  as  many  as  three  hundred 
sick  under  their  care,  were  compelled  to  buy  the 
medicines  for  the  patients  out  of  their  salaries. 
It  is  probable  that  in  those  wards  treatment 
by  the  excessive  use  of  drugs  was  regarded  with 
disapproval. 

The  instructive  thing  about  all  of  this  tragedy 
is  that  the  male  officials  who  were  in  charge  quite 
generally  felt  that  these  methods  were  satisfactory 
and  that  improvement  was  unnecessary.  No 
wonder,  with  such  standards,  that  the  visits  of 
women  from  outside,  who  dared  to  criticise  and 
question,  were  regarded  as  unendurable  and  pry- 
ing impertinences. 

After  visiting  the  south-western  counties,  with 
fifty-eight  workhouses,  the  report  of  the  Poor  Law 
Inspector  said:  ''Nursing  generally  satisfactory; 
almost  every  infirmary  having  one  paid  nurse,  and 
one  or  more  helpers."  And  yet  this  district  had 
one  infirmary  where  there  were  two  hundred  and 
fifty-one  sick,  including  the  insane,  and  only  six 
nurses  with  nineteen  pauper  helpers,  while  there 
was  no  night  nursing  existent  in  any  of  the  work- 
houses. Another  Poor  Law  Inspector  must  be  com- 
mended as  having  a  little  more  intelligence  than 
the  first  mentioned.  After  visiting  one  workhouse 
where  no  division  was  made  between  medical  and 
surgical    patients,  where    the    itch    was    classed 


292  A  History  of  Nursing 

as  "vagrancy,"  where  one  wash-basin  and  one 
roller-towel  were  allowed  weekly  in  wards  of  from 
eight  to  fourteen  patients,  where  one  woman 
nurse  with  a  male  helper  had  charge  of  seventy 
insane  patients  of  both  sexes,  and  where  one  other 
nurse  had  under  her  sole  care  one  hundred  and 
fifty  sick  persons,  this  man  of  rare  perception  and 
firmness  said,  "Although  the  medical  officer  is 
contented  with  the  existing  conditions  of  the  in- 
firmary, I  do  not  consider  it  in  a  satisfactory 
state." ' 

In  1855  a  proposal  was  made  by  a  society  of 
physicians,  of  whom  Dr.  Sieveking  was  foremost, 
to  train  the  numerous  able-bodied  women  in  the 
workhouses  as  nurses.  Miss  Twining  in  speaking 
of  this  could  not  approve  the  plan,  as  these  women 
were  usually  of  bad  character,  and  although  it  was 
sanctioned,  and  the  Board  of  Guardians  had  in- 
structions to  carry  it  out,  it  never  actually  took 
form.^ 

In  1857  an  association  was  formed  through  Miss 
Twining 's  efforts  called  the  Central  Society  for  the 
Promotion  of  Workhouse  Visiting,  and  two  years 
later  it  started  its  own  journal.  This  society, 
affiliated  with  the  Social  Science  Association, 
carried  on  the  work  of  workhouse  reform.  The 
greatest  circumspection  was  necessary,  for  Miss 
Twining  relates  the  incident  of  a  body  of  visitors 

>  A  Century  of  Nursing.  Reports  of  the  State  Charities  Aid 
Association  of  New  York  State,  1876.  Quoting  from  Parlia- 
mentary Papers,  vols.  Ix.-lxi.,  1866-68. 

2  Recollections,  p.  17. 


Miss  Nightingale's  Co-Workers    293 

being  dismissed  from  a  London  workhouse  in  con- 
sequence of  complaints  of  well-nigh  unendurable 
grievances  endured  by  the  inmates  and  noticed  by 
a  lady — a  person  of  influence  and  position,  as  well 
as  humanity.^ 

In  1866  the  Lancet  made  an  exhaustive  investi- 
gation into  the  sick  wards  of  the  London  work- 
houses, and  brought  many  abuses  to  light. 

Not  until  1872  was  the  great  gain  made  of  hav- 
ing a  woman  appointed  as  official  in  spector  of  the 
metropolitan  workhouses. 2  Not  easily  could  men 
be  brought  to  see  the  necessity  of  this,  for,  as  Miss 
Carpenter  had  once  said,  "There  never  yet  lived 
a  man  so  clever  but  the  matron  of  an  institution 
could  bamboozle  him  about  every  department  of 
her  business."^ 

A  lovely  outcome  of  Miss  Twining 's  work  was 
the  establishment  of  the  Flower  Mission,  which  has 
brought  solace  to  so  many  bedridden  patients. 
She  soon  found  that  flowers  were  the  one  gift  that 
excited  no  animosity,  and  began  in  1858  taking 
them  systematically  to  her  sick  people.  From 
this  grew  up  in  time  the  organised  society  which 
has  since  then  done  so  much  to  bring  joy  into 
hospital  wards. 

The  education  of  the  public  carried  on  by  Miss 
Twining  through  all  these  years  has  been  of  simply 
enormous  extent.  Her  most  irresistible  weapon 
has  been  the  absolute  accuracy  of  her  every  state- 

^ Recollections,  p.  60.     2  Ibid.,  p.  66. 
'  Frances  Power  Cob  be,  Life,  p.  306. 


294  A  History  of  Nursing 

ment.  Moderate  and  exact  in  the  use  of  words, 
steadfast,  merciful,  and  convincing,  she  has  been 
to  the  workhouses  what  Mrs.  Fry  was  to  the  pris- 
ons and  Miss  Nightingale  to  the  hospitals. 

The  introduction  of  trained  nursing  into  work- 
house infirmaries  was  accomplished  by  Agnes 
Elizabeth  Jones,  one  of  the  most  beloved  of  the 
pioneers  in  nursing,  and  one  who  was  a  martyr 
to  the  cause,  but  it  was  the  well-planned  under- 
taking of  Mr.  Wm.  Rathbone,  a  Quaker  of  Liver- 
pool, who  has  had  a  very  important  part  in 
the  progress  of  English  nursing. 

The  illness  and  death  of  his  wife  in  1859  first 
turned  Mr.  Rathbone's  attention  to  nursing.  The 
thought  of  how  the  poor  must  suffer  in  illness 
prompted  him  to  try  an  experiment,  and  he  en- 
gaged the  woman  who  had  been  his  wife's  nurse, 
and  who  was  capable  and  kindly,  to  work  among 
the  poor  of  the  city.  He  paid  her  a  salary,  and 
provided  nourishment  and  appliances  for  the  sick. 
The  results  encouraged  him  and  he  wished  to 
extend  the  ser\'ice,  but  there  were  no  m.ore  nurses 
to  be  had.  He  went  to  Miss  Nightingale  for  ad- 
vice, and  she  counselled  him  to  try  to  train  nurses 
in  Liverpool,  at  the  Royal  Infirmary.  The  com- 
mittee of  this  hospital  was  anxious  to  improve 
the  nursing,  and  offered  Mr.  Rathbone  a  seat  on 
their  board.  His  response  was  to  offer  to  build 
a  training  school  and  home  for  nurses  and  give  it 
to  the  infirmary.  He  wrote  to  Agnes  Jones  to 
offer  her  the  position  of  superintendent,  but,  as  we 


Miss  Nightingale's  Co-Workers     295 

shall  see,  this  was  not  to  be,  and  finally  Miss  Merry- 
weather  went  to  St.  Thomas's  for  training,  then 
took  the  post,  and  gave  admirable  service  there. 
She  trained  nurses  for  the  wards  and  for  district 
nursing,  and  the  city  was  divided  into  eighteen 
districts  with  a  nurse  and  a  group  of  lady  visitors 
for  each.  So  practical  was  Mr.  Rathbone  that 
for  a  whole  year  he  made  rounds  regularly  with 
some  one  of  the  nurses,  to  see  conditions  for 
himself. 

The  next  thing  that  impressed  him  was  to  learn 
that  the  poor  abhorred  the  thought  of  going  to 
the  parish  infirmary,  and  he  studied  its  conditions. 
There  were  twelve  hundred  sick  there,  in  every 
stage  of  misery,  and  none  but  pauper  untrained 
help.  Mr.  Rathbone  urged  bringing  in  a  trained 
superintendent  with  a  group  of  nurses,  and,  as 
the  authorities  were  very  unwilling  to  incur  any 
expense,  he  offered  to  defray  the  whole  cost  of  the 
experiment  for  three  years'  time.  They  agreed  to 
this,  and  he  now  offered  this  second  and  infinitely 
more  difficult  piece  of  work  to  Agnes  Jones,  secured 
twelve  Nightingale  nurses  to  assist  her,  and  on  the 
1 6th  of  May,  1865,  this  little  group  of  women  be- 
gan their  renovation  of  the  infirmary  with  eigh- 
teen probationers  and  fifty-four  of  the  old  pauper 
nurses.^ 

Agnes  was  born  in  Cambridge  in  1832,  and  from 
her  early  girlhood  she  was  restless  with  the  eager 

»  William  Rathbone:  A  Memoir,  by  Eleanor  F.  Rath" 
bone.    Macmillan  &  Co.,  London,  1905,  pp.  156-173. 


296  A  History  of  Nursing 

desire  to  be  of  real  usefulness.  Beside  a  natural 
gift  for  bringing  help  and  cheer  to  those  around 
her  she  was  also  of  excellent  executive  ability  and 
mental  acumen.  She  was  deeply  imbued  with  the 
excessive  evangelical,  sentimental  piety  prevalent 
at  that  time  (the  continuous  outpourings  of  which 
in  speech  and  writings  seem  now  so  self-conscious 
and  imctuous) ,  but  had  the  true  missionary  spirit. 
In  her  travels  on  the  continent  she  \isited  Kai- 
serswerth  and  other  deaconess  establishments, 
and  was  at  first  greatly  drawn  to  that  life, 
though  later,  as  she  recorded  in  her  diary,  she 
concluded  that  one  could  do  as  well  out  of 
as  in  the  deaconess  order.  For  seven  years 
after  her  visit  she  longed  to  go  to  Kaiserswerth  for 
training,  and  at  last  her  family,  who  were  of  the 
leisured  and  cultured  class,  rather  unwilling  to 
have  her  take  this  then  unusual  step,  consented, 
and  she  spent  a  year  there,  from  i860  to  1861. 
Her  letters  from  Kaiserswerth,  and  her  descriptions 
of  the  life  are  very  interesting  and  give  realistic 
and  graphic  pictures  of  the  daily  round.  While 
in  training  a  number  of  opportunities  of  work 
offered  themselves  to  her — one  to  go  to  Syria, 
another  to  help  Mrs.  Ranyard  in  the  Bible  ]\Iission 
and  district  work,  and  Mr.  Rathbone's  first  offer 
to  come  to  Liverpool. 

She  felt  drawn  to  each,  as  an  ardent  explorer 
does  to  new  countries,  but  her  chief  purpose  then 
was  to  prosel\i:ise.  It  cannot  but  strike  one  oddly 
that  she  should  write  to  Mr.  Rathbone,  himself 


Miss  Nightingale's  Co- Workers    297 

one  of  the  salt  of  the  earth,  a  very  pillar  of  good- 
ness, in  this  pedantic  tone:  "You  send  me  the 
ground  plan  of  the  building,  but  I  would  ask,  Is 
its  foundation  and  corner-stone  to  be  Christ  and 
Him  crucified,  the  only  Saviour?  Is  the  Christian 
training  of  nurses  to  be  the  primary  and  hospital 
skill  the  secondary  object?  ...  I  shall  not  em- 
bark in  any  work  whose  great  aim  is  not  obedi- 
ence to  the  command  *  Preach  the  Gospel  to  every 
creature.'  ..." 

As  the  results  of  this  attitude  might  have  been 
doubtful  in  hospital  work,  the  plan  went  no  further 
then,  and  Agnes  completed  her  term  at  Kaiser s- 
werth  and  returned  to  London.  She  became 
more  and  more  attracted  to  the  definite  work  of 
nursing,  and  consulted  Miss  Nightingale  about  the 
advisability  of  entering  St.  Thomas's  for  the  train- 
ing. Her  family  was  unwilling  to  have  her  take 
this  step,  and  even  she  herself  hesitated,  partly  be- 
cause of  the  social  inferiority  of  most  of  the  older 
type  of  nurses ;  but  at  last,  after  some  work  with 
Mrs.  Ranyard  in  the  Mission,  and  more  travels  to 
centres  of  work  and  training  abroad,  her  mother 
finally  consented  and,  having  first  had  a  personal 
interview  with  Mr.  Rathbone,  she  went  to  St. 
Thomas's  as  a  Nightingale  nurse,  and  afterwards, 
with  twelve  other  Nightingale  nurses  revolution- 
ised the  great  workhouse  infirmary  at  Liverpool, 
established  order,  training,  a  moral  atmos- 
phere, cheerfulness,  cleanliness,  and  good  nursing, 
giving  a  wonderful  demonstration  of  what  can  be 


298  A  History  of  Nursing 

accomplished  by  skill  and  devotion.  Her  achieve- 
ment was  accented  by  her  death.  After  three 
years  of  labour  so  untiring  and  exacting  that  she 
scarcely  had  time  to  write  letters  to  her  family, 
she  died  of  t^^^hus  fever  in  the  hospital. 

From  her  splendid  demonstration  in  the  Liver- 
pool workhouse  extended  all  the  reforms  in  the 
nursing  methods  of  similar  institutions.  During 
her  brief  illness  Miss  Nightingale  wrote  to  her  fam- 
ily, "  I  look  upon  hers  as  one  of  the  most  valuable 
lives  in  England,  in  the  present  state  of  the  poor 
law  and  of  workhouse  nursing."  And  after  her 
death  she  wrote  the  exquisite  tribute  to  her  mem- 
ory which  forms  the  preface  to  her  biography.  ^ 

Another  figure  stands  out  prominently  among 
the  pioneers  of  that  day  and  followers  of  Miss 
Nightingale  —  ]^Iiss  Florence  Lees,  now  ]\Irs.  Da- 
cre  Craven,  whose  chief  distinction  was  in  im- 
proving the  district  nursing  service.  Although 
she  did  much  more  than  this,  it  is  with  this  that 
her  name  is  especially  associated,  as  Agnes  Jones's 
with  the  workhouses  and  Mrs.  Wardroper's  w4th 
the  training  of  nurses.  Florence  Lees  was  one  of  the 
first  four  pupils  who  entered  the  Nightingale 
school.  She  has  been  called  the  most  highly 
trained  nurse  of  her  day,  and  probably  was 
so.  After  training  at  St.  Thomas's  she  had 
post-graduate  courses    in    Berlin,    Dresden,    and 

»  See  Una  and  her  Paupers:  Memorials  of  Agnes  Elizabeth 
Jones,  by  her  Sister.  First  American  from  the  second  Eng- 
lish ed.     London,  James  Xisbet  Co.,  1885  ;  Xew  York,  1872. 


Miss  Nightingale's  Co-Workers    299 

Kaiserswerth ;  was  surgical  Sister  in  Kings 
College  hospital;  then  made  a  tour  of  in- 
spection through  the  hospitals  of  Holland  and 
Denmark.  She  was  then  able  to  gain  entrance 
for  training  in  the  Hotel-Dieu,  Lariboisiere,  and 
Enfant  Jesus  hospitals  of  Paris,  and  later  served 
under  the  Sisters  of  Charity  of  St.  Vincent  de  Paul 
in  two  military  hospitals,  where  she  was  allowed 
to  pass  through  every  department,  from  the  kitch- 
ens and  linen-rooms  to  the  operating  theatre.  In 
the  Franco- Prussian  war  she  had  charge  of  a 
military  hospital  before  Metz,  and  of  the  ambu- 
lance service  supported  by  the  Crown  Princess  of 
Germany.* 

After  Mr.  Rathbone's  experiment  with  his  first 
district  nurse  his  example  was  quite  widely  imi- 
tated, and  in  London  the  East  London  Society, 
organised  for  the  sole  benefit  of  the  poor,  was 
formed  in  1868. 

In  18742  the  order  of  St.  John  of  Jerusalem  inaug- 
urated the  National  Nursing  Association  to  pro- 
vide more  fully  trained  nurses  for  the  poor,  and 
under  the  auspices  of  this  association  a  very  im- 
portant investigation  was  carried  on  under  the  di- 
rection of  Miss  Lees,  who  was  chairman  of  the 
Committee  of  Inquiry.  It  was  found  that  the  whole 
system  of  district  nursing  then  existing  was  very 
amateur,  slovenly,  and   haphazard.     The  nurses 

1  See  pp.  xvi-xvii  Handbook  for  Hospital  Sisters,  by  Flor- 
ence S.  Lees.  Preface  by  Henry  Acland,  M.D.,  F.R.S.  W. 
Isbister  Co.,  London,  1874. 

2  See  Times,  June  23,  June  26,  1874. 


300  A  History  of  Nursing 

were  often  almoners  rather  than  nurses,  and  the 
connection  with  the  physician  was  very  lax.  The 
nurses  often  prescribed,  and  boasted  of  "curing 
wounds  which  no  doctor  had  ever  seen."^ 

With  this  report  Miss  Lees  made  the  recommend- 
ation and  carried  the  point  which  has  proved  to 
be  of  such  conspicuous  benefit  to  the  service  and 
with  which  her  name  must  always  be  associated, 
viz.,  that  district  nurses  should  be  entirely  re- 
cruited from  the  class  known  as  gentlewomen. 
It  was  at  first  regarded  as  an  impossibility.  Even 
Miss  Nightingale  doubted,  and  said  to  Miss  Lees, 
"I  don't  believe  you  will  find  it  answer;  but  try 
it — try  it  for  a  year."  Miss  Lees's  arguments  for 
her  side  were  those  which  are  to-day  regarded  as 
axiomatic,  and  need  not  be  repeated.  She  w^as 
able  to  carry  them  into  practice,  and  the  results 
amply  justified  her.  The  association  was  ex- 
tended as  indicated  by  the  title  Metropolitan  and 
National  Nursing  Association,  and  Miss  Lees  be- 
came the  first  superintendent  of  the  Central  Home. 

To  the  English  system  of  permanency  of  Sisters 
or  head  nurses  and  of  staff  nurses  or  seniors,  which 
was  retained  and  not  discarded  when  the  reform 
of  nursing  took  place,  is  chiefly  due  the  homelike, 
serene,  and  cheerful  atmosphere  so  characteristic 
of  English  hospitals,  which  are,  in  a  final  compari- 

»  See  Mrs.  Dacre  Craven's  paper  on  "District  Nursing,"  read 
at  the  Congress  of  Charities  and  Correction,  World's  Fair, 
Chicago,  1893.  Transactions  of  Section  on  Hospitals,  Dis- 
pensaries, and  Nursing,     p.  547. 


Miss  Nightingale's  Co-Workers    301 

son,  the  pleasantest  and  most  comfortable  for  the 
patients  in  the  world.  The  Sister  remains  at  the 
head  of  her  ward  for  years;  only  leaving,  often,  to 
retire  from  service :  the  staff  nurses  or  seniors  also 
remain  for  long  periods,  five,  eight,  ten  years;  the 
probationers  come  and  go,  during  their  three  or 
four  years'  course,  and  the  entire  current  is  more 
steady,  more  settled,  less  strenuous,  less  kaleido- 
scopic than  is  possible  when  an  entire  hospital 
nursing  force  changes  throughout  in  two  or  even 
three  years'  time.^  The  English  matrons,  also, 
have  a  more  permanent  tenure  of  office  than  ours ; 
their  duties,  privileges,  boundaries,  and  authority 
are  more  clearly  recognised,  and  less  frequently 
disputed  or  encroached  upon.  They,  too,  often 
remain  for  a  working  lifetime  at  the  head  of  their 
households  as  contentedly  as  a  mother  at  the  head 
of  her  family.  It  is  true  that  this  security  of  ten- 
ure may  conduce  to  a  narrow  outlook  or  excessive 
conservatism,  but  these  errors  are  avoided  by  con- 
tact with  the  world,  and  exist  as  well  in  our  more 
unstable  environment.  Though  changes,  under 
the  English  system,  are  more  slowly  made,  even 
when  desirable,  they  are  more  definitely  settled 
and  more  generally  acquiesced  in  when  once  made. 

1  It  is  common  to  see  in  the  English  nursing  press  such  notes 
as  these: 

"Miss  Eliza  Whitmore,  known  to  medical  men  and  nurses 
at  St.  George's  hospital  as  '  Sister  Nannie, '  has  retired  from 
active  work  after  twenty-five  years  of  devoted  service  to  the 
hospital. " 

"A  presentation  was  recently  made  at  the  Norfolk  and 


302  A  History  of  Nursing 

The  report  already  mentioned,  written  for  the 
British  Medical  Journal  in  1874,  may  now  be 
turned  to  again  for  a  graphic  and  w^ell  touched-up 
picture  of  the  general  conditions  of  the  hospitals 
at  that  date,  fourteen  years  after  the  opening  of 
the  Nightingale  school.  The  earlier  conditions 
have  been  described;  now,  in  1874,  there  were  the 
St.  John's  House  Sisters  at  King's  College  and  at 
Charing  Cross ;  the  Sisters  of  All  Saints  at  Univer- 
sity College  hospital,  and  the  Nightingale  Sisters 
at  St.  Thomas's.  At  St.  George's  and  the  Middle- 
sex the  Sisters,  though  not  ladies,  were  of  rather  a 
better  social  class  than  the  nurses.  The  old  plan 
of  having  a  permanent  and  rather  inferior  class  of 
night  nurses  was  still  in  force  at  St.  Mary's,  St. 
George's  and  the  London. 

St.  Bartholomew's  had  had  until  recently  the 
German  system  of  each  nurse  taking  in  turn  one 
night  duty  every  third  night,  making  nearly  thirty 
hours  of  continuous  duty.  Then  (1874)  each  nurse 
had  one  week  of  night  duty  alternating  with  two 
weeks'  day  duty. 

The  old  plan  of  giving  board  money  was 
nearly  extinct.  It  still  lingered  in  a  modified  form 
at  St.  Bartholomew's,  where  the  Sisters  had  to 
provide  a  great  part  of  their  own  food,  whilst  the 
nurses  received  uncooked  rations  of  meat,  flour, 
and  vegetables. 

Norwich  hospital  of  a  purse  of  fifty-five  sovereigns  to  Sister 
Bessey,  who  is  about  to  retire  after  thirty-eight  years'  ser- 
vice. She  entered  the  hospital  for  training  in  1868  and  was 
appointed  Sister  in  1875.". 


Miss  Nightingale's  Co-\Vorkers    303 

The  special  commissioner  speaks  of  the  question 
of  the  "  lady  nurse  "  as  a  "  burning ' '  one.  It  really 
meant  an  entire  reorganisation  of  hospital  work, 
and  some  hospital  directors  were  much  opposed 
to  ''lady  nurses,"  because  of  the  necessity  it  in- 
volved of  a  separate  staff  for  rough  housework. 
It  was  hard  for  some  men  to  hear  that  the  nurse 
must  cease  being  a  scrubber;  but  others  pointed 
out  the  difficult  and  unpleasant  nature  of  many 
purel}^  nursing  duties  and  insisted  on  the  absurdity 
of  taking  up  the  time  of  trained  persons  to  do  un- 
skilled labour,  making  it  clear  that  the  division 
of  labour  proposed  did  not  mean  that  scrubbing 
was  degrading  or  menial,  but  that  the  nurse  should 
be  free  to  nurse,  and  not  be  taken  away  from  the 
patient  to  scrub.  A  great  improvement  was  re- 
corded in  the  general  average  of  education  among 
nurses.  Thus  in  1867  in  a  large  provincial  hos- 
pital seven  out  of  twenty  nurses  could  not  read  or 
write,  and  three  of  these  were  head  nurses.  But 
in  1874  no  hospital  would  accept  nurses  unless  they 
could  read  and  write.  There  was  a  distinct  im- 
provement in  the  quality  of  woman  applying,  and 
in  the  majority  of  London  hospitals  the  Sisters 
were  ladies. 

The  improvement  advanced  but  slowly,  writes 
Mrs.  Strong: 

In  the  Glasgow  infirmary  at  the  beginning  of  the 
last  quarter  century  (about  1870)  a  nurse  had  to  begin 
as  a  semi-wardmaid  under  the  name  of  assistant  nurse 
and  work  her  way   without   any  direct  instruction. 


304  A  History  of  Nursing 

She  was  called  at  3  a.m.,  and  began  work  at  4,  clean- 
ing grates,  scullery,  and  bath-room,  sweeping  and  dust- 
ing the  ward,  etc.  She  also  carried  the  food  for  the 
ward  supply,  washed  the  dishes,  and  did  much  heavy 
carrying  which  is  now  done  by  men.  Her  duties 
ended  at  8.30  p.m.,  without  any  definite  time  off  duty. 
Most  of  the  women  slept  in  small  rooms  adjoining  the 
wards  and  took  their  meals,  with  the  exception  of 
dinner,  in  the  ward  kitchens.  Xurses  and  servants 
shared  the  same  dining-room  and  had  to  carry  a  knife, 
fork,  and  glass  with  them.^ 

The  deliberation  with  which  the  English  hos- 
pitals adopted  the  new  order  is  shown  in  a  delight- 
fully gossipy  reminiscence  of  one  of  the  Sisters  of 
the  first  class  of  probationers  at  St.  Bartholo- 
mew's hospital  (which  later  rapidly  moved  to  the 
very  front  of  progress  on  practical,  social,  and 
educational  lines)  when  the  change  was  instituted 
there : 

.4  Reformation. —  ...  I  came  in  on  May  i,  1877, 
just  five  and  twenty  years  ago.  I  was  one  of  a  batch 
of  twelve  probationers,  the  first  to  be  trained  at  St. 
Bartholomew's  hospital.  Before  we  came  there  was 
no  sort  of  training  for  the  nurses,  and  of  nursing  as 
one  understands  it  now  there  was  simply  none.  The 
matron,  Mrs.  Drake,  greatly  disapproved  of  such  an 
innovation  as  "lady  nurses,"  and  tried  hard  to  dissuade 
me  from  entering  when  I  came  up  to  be  interviewed. 
There  was  no  entrance  examination.  AVe  all  arrived 
one  morning  and  proceeded  to  put  on  our  uniform. 

1  " Preliminary  Work,"  by  Mrs.  Strong.  International 
Congress  of  Xurses,  Buffalo,  1901.      Transactions. 


Miss  Nightingale's  Co-Workers    305 

What  was  it?  The  present  probationer's  uniform, 
with  the  exception  of  the  caps,  which  were  small  caps 
without  strings.  This  was  quite  different  from  the  uni- 
form of  the  so-called  "staff-nurses,"  who  wore  brown 
merino  dresses,  aprons  without  bibs,  collars,  no  cuffs, 
caps  or  no  caps  as  they  liked,  and,  when  worn,  of  any 
description.  I  remember  hearing  some  weeks  after 
we  arrived  that  the  head  dispenser  had  pronounced 
us  "an  ornament  to  the  square." 

In  the  afternoon  we  attended  a  lecture  by  Sir  Dyce 
(then  Dr.)  Duckworth  in  the  lecture-theatre.  Though 
especially  for  our  benefit,  it  was  an  open  lecture.  A 
few  of  the  Sisters  and  staff  nurses  were  there,  and 
many  students.  .  .  .  Curiosity  brought  them,  I  sup- 
pose. We  were  something  quite  new  and  caused  a 
considerable  stir  in  the  place. 

That  night  I  was  sent  to  "Harley,"  where  I  shared 
a  room  opening  into  the  ward  (the  "dressing-room") 
with  the  staff  nurses.  I  did  not  get  much  rest.  To 
begin  with,  my  roommate  was  very  drunk  and  very 
sick.  Being  ignorant  of  the  symptoms  I  wasted  much 
pity  on  her.  When  I  did  fall  off  to  sleep,  I  was  awak- 
ened by  frightful  screams  and  shouts  of  ' '  Murder ! 
Fire!"  I  proceeded  to  wake  my  companion,  who 
growled,  "Be  quiet:  it's  only  i8."  Drunkenness  w^as 
very  common  among  the  staff  nurses,  who  were  chiefly 
women  of  the  charwoman  type,  frequently  of  bad 
character,  with  little  or  no  education,  and  few  of  them 
with  even  an  elementary  knowledge  of  nursing.  Some 
of  them  might  have  worked  previously  at  some  other 
hospital,  but  as  often  as  not  they  had  had  no  experi- 
ence whatever  when  engaged  as  staff  nurses.  One 
woman,  I  remember,  who  came  some  little  time  after 
I    did    and    under    whom    I    worked,    had    been    a 

VOL.  II  — 20 


3o6  A  History  of  Nursing 

lady's-maid,  and  had  never  done  a  day's  nursing. 
She  was,  however,  of  a  decidedly  superior  class  to  any 
of  the  others,  and  was,  moreover,  quite  respectable. 
It  was  very  usual  for  the  friends  to  bring  in  presents 
of  gin  to  bribe  the  nurses  to  be  kind  to  the  patients. 
The  worst  women  we  had  were  those  who  used  to 
come  in  to  look  after  bad  cases,  more  particularly  at 
night.  They  were  called  "night  extras."  They  were 
most  dreadful  persons,  possessing  neither  character 
nor  ability,  who  used  to  apply  here  for  work  much  as 
women  now  apply  for  charing.  I  remember  being 
so  horrified  soon  after  I  came  at  the  idea  of  a  very 
bad  case  (a  man  whose  leg  was  amputated  at  the 
thigh)  being  left  to  the  tender  mercies  of  one  of  these 
creatures,  that  I  summoned  up  courage  to  ask  Sister 
Harley  to  put  me  on  as  "special"  instead.  She  con- 
sented, and  I  looked  after  him  in  the  daj^ime;  at 
night,  of  course,  he  had  the  "lydy"  from  outside. 

Among  the  Sisters  there  was  already  some  improve- 
ment. Some  there  still  were  of  whose  virtues  the  less 
said  the  better,  and  some  were  wholly  untrained,  a 
knowledge  of  nursing  not  being  in  those  days  a  neces- 
sary qualification  for  a  Sister.  Sister  Pitcairn,  how- 
ever, had  been  for  a  year  or  two  in  Pitcairn,  and  was 
undoubtedly  much  the  most  highly  trained  nurse  then 
in  the  hospital,  and  Sister  Eyes  was  the  ophthalmic 
Sister,  the  first  to  be  appointed  for  that  special  work. 
A  few,  also,  had  been  trained  in  the  Nightingale 
Home.  We  should  not  think  much  now  of  the  train- 
ing they  had  had,  but  it  was  a  good  deal  for  that  time. 
They  also  had  had  considerable  experience,  and  were, 
moreover,  clever  and  capable  women  of  superior 
character. 

How  were  we  taught?     Well,  by  the  Sisters  very 


Miss  Nightingale's  Co-Workers    307 

little.  (The  staff  nurses  were  not  capable  of  teaching 
anything.)  Few  of  the  Sisters  both  could  and  would 
teach  us.  I  do  not  think  any  Sister  taught  me  any- 
thing except  Sister  Matthew  (as  she  was  then)  and 
Sister  Pitcaim.  Sir  Dyce  Duckworth  or  Mr.  Willett 
lectured  to  us  or  gave  a  practical  demonstration  once 
a  week.  Mr.  Willett  used  to  have  in  his  out-patient 
children  and  teach  us  to  bandage,  put  on  splints,  to 
make  and  apply  plasters,  bandages,  and  so  on.  Sir 
Dyce  would  take  us  into  the  wards  and  give  us  a  lesson 
on  bed-making,  poultice-making,  or  on  the  contents 
of  the  doctor's  cupboard,  or  down  to  the  bath-rooms, 
where  he  and  old  Williams,  the  bathman,  used  to 
show  us  the  best  way  to  get  patients  in  and  out  of  the 
bath,  and  how  to  prepare  special  baths  of  various 
kinds.  We  were  known  as  "Ducky's  lambs."  .  .  . 
The  present  bath-rooms  off  the  wards  were  only  just 
being  built.  Before  we  had  them  all  patients  who 
were  in  fit  condition  were  bathed  in  the  baths  under 
the  out-patient  department.  The  only  baths  in  the 
wards  were  in  the  kitchens,  and  were  covered  over 
with  wooden  covers,  which  often  served  as  a  table  on 
which  to  carve  the  dinners. 

Then,  we  picked  up  what  we  could,  and  the  resi- 
dent staff  and  students  taught  us  a  good  deal.  .  .  . 
We  were  quite  a  novelty,  and  every  one  took  a  great 
interest  in  us.  Dr.  Griffith,  I  think,  taught  me  to 
take  temperatures.  He  was  a  dresser.  The  ther- 
mometers in  use  then  were  very  much  longer  than 
those  we  use  now,  and  had  to  be  read  while  in  posi- 
tion, as  they  ran  down  at  once  when  removed  from 
the  mouth  or  armpit.  They  cost  twelve  shillings 
sixpence  each.  The  Sisters  and  nurses  never  used 
a  thermometer,  the  dressers  and  clerks  took  the  tern- 


3o8  A  History  of  Nursing 

peratures  when  required.  We  probationers  were  ex- 
pected to  learn  the  use  of  the  cUnical  thermometer, 
but  there  was  generally  a  row  if  a  Sister  caught  us 
with  one. 

To  show  you  how  little  we  were  shown  our  work, 
I  must  tell  you  two  things  I  remember  having  to  do 
within  my  first  month.  One  day  a  sweep  was  brought 
into  Harley  straight  from  his  work  with  six  fractured 
ribs.  "  Pro,"  said  Sister,  "go  and  wash  that  patient." 
I  had  never  been  shown  how  to  set  about  such  a  task, 
and  his  hair  alone,  which  was  full  of  soot,  nearly  drove 
me  to  despair.  Another  day  I  was  ordered  to  give  soap- 
and-water  injections  to  the  same  man,  and  also  to  a 
man  with  a  very  bad  compound  fracture  of  the 
femur.  I  had  never  given  one  before,  and  had  no 
instructions  whatever  given  to  me.  I  know  I  was  in 
tears  before  I  had  finished,  and  so,  I  fear,  were  the 
patients.  We  had  always  to  find  out  things  for 
ourselves. 

**  How  did  we  get  on  with  the  staff  nurses?  On  the 
whole,  very  well.  You  see,  our  coming  brought  about 
several  improvements.  To  begin  with,  before  then 
all  the  three  nurses  (night  and  day)  shared  the  one 
small  bedroom,  sleeping  "Box  and  Cox."  When  we 
came  the  "night  home  "  was  arranged  to  accommodate 
the  night  nurses,  which  left  only  the  two  day  nurses 
to  sleep  in  the  ward  bedroom.  Then  a  dining-room 
was  also  made  (part  of  our  present  library),  where 
breakfast  and  dinner  were  provided.  Tea  we  had  in 
the  ward  (not  in  the  kitchen) ,  and  for  supper  we  had 
only  what  we  chose  to  get  for  ourselves  before  going 
to  bed.  Before  we  came  all  the  nurses'  food  was 
cooked  and  eaten  in  the  wards,  as  also  the  Sisters'. 
The  Sisters  had  no  dinner  provided.     They  were  given 


Miss  Nightingale's  Co-Workers    309 

a  chop  (uncooked)  on  Sundays  only.  They  lived 
entirely  in  their  rooms,  which  were  half  the  size  most 
of  them  are  now. 

What  hours?  We  were  on  duty  from  7  a.m.,  until 
10  P.M.  Twice  a  week  we  were  supposed  to  go  off 
duty  for  two  hours,  6  to  8  p.m.,  and  to  have  a  half- 
day  (3  to  9)  once  a  fortnight.  I  say  "supposed,"  as 
we  never  got  off  punctually:  the  work  could  not  be 
finished  in  time.  When  we  came  in  we  went  on  duty 
again  until  ten  o'clock. 


Of  course,  nursing  as  you  understand  it  now  was 
utterly  unknown.  Patients  were  not  "nursed"  then; 
they  were  "attended  to,"  more  or  less,  but  there  was 
only  one  nurse  on  each  side  of  the  ward,  and  the  work 
was  very  hard — lockers,  locker-boards,  and  tables,  of 
course,  to  scrub  every  day.  We  did  not,  as  a  rule, 
scrub  the  floors,  though  I  have  scrubbed  the  whole  of 
the  front  ward  of  Matthew  (Faith)  on  a  special  occa- 
sion before  6  a.m.  Luke  was  the  only  ward  where 
the  floor  was  scrubbed  daily,  each  nurse  doing  her 
half,  and  Sister  herself  lending  a  hand  if  they  were 
very  busy.  (Luke  was  considered  a  particularly 
smart  ward  in  those  days,  and  Sister  always  wore  a 
black  silk  dress  when  she  went  round  with  the  visiting 
physician.)  The  patients  had  their  beds  made  once 
a  day,  the  bad  cases  had  their  sheets  drawn  at  night. 
In  Matthew  all  of  the  patients  got  out  of  bed  every 
day,  even  the  typhoids — it  was  considered  rather 
smart.  Then  one  thought  nothing  of  having  fourteen 
or  fifteen  poultices  to  change.  All  wounds,  of  course, 
suppurated,  and  required  dressing  or  poulticing  twice 
or  three  times  a  day.     I  well  remember  Mr.  Willett 


310  A  History  of  Nursing 

saying,  when  lecturing  to  us  on  wounds,  "There  are 
three  modes  of  heaHng:  the  first,  most  to  be  desired 
but  never  seen,  by  first  intention;  the  second  by 
granulation;  and  the  third,  which  is  always  seen,  by 
suppuration." 

What  was  our  life  in  the  home  like?  There  was 
nothing  of  the  sort.  We  had  breakfast  and  dinner 
in  the  home ;  otherwise,  when  off  duty,  if  we  did  not 
go  out,  we  sat  in  the  ward  kitchens  or  in  our  bedrooms. 
The  food  was  fairly  good.  There  was  no  one  to  over- 
look our  behaviour  or  to  see  that  we  went  to  bed  at 
the  right  time,  or  anything  of  that  sort.  Indeed,  I 
often  sat  up  very  late,  and  when  in  Faith  went  round 
frequently  with  Sister  and  the  house  physician  when 
they  made  the  night  round.  I  learned  a  good  deal 
then.  I  generally  had  to  write  my  lectures  out  before 
I  got  up  in  the  morning,  between  five  and  six.  It  was 
the  only  quiet  time  and  the  only  time  of  the  day  when 
my  head  was  clear  enough :  at  night  I  was  too  tired. 

At  the  end  of  the  year  we  passed  an  examination 
held  much  on  the  same  lines  as  now,  but  I  believe  that 
marks  were  not  awarded  by  the  miatron  until  after 
Miss  Manson  came  (Mrs.  Bedford- Fen  wick).  We 
were  awarded  certificates  and  offered  posts  as  staff 
nurses,  which  few  were  bold  enough  to  accept  on 
account  of  the  existing  condition  of  things. 

We  objected  to  associating  constantly  and  sharing 
rooms  with  the  staff  nurses,  to  changing  our  clean 
cotton  uniforms  for  their  brown  stuff  dresses,  and  to 
carrying  the  soiled  linen  from  the  wards  to  the  laundry 
(which  the  staff  nurses  had  then  to  do),  and  various 
other  things.  The  treasurer  promised  to  try  and  alter 
these  things,  and  did  by  degrees. 

Things  improved  little  by  little.     One  or  two  out 


Miss  Nightingale's  Co- Workers    311 

of  every  batch  of  probationers  (they  came  in  every 
three  months)  stayed  on  after  passing  the  examina- 
tion. Then  Miss  Machin,  who  became  matron  in 
1879,  increased  the  period  of  training  to  two  years,  so 
that  we  had  a  certain  number  of  second- year  nurses 
on  whom  we  could  depend.  It  was  not,  however, 
until  after  Mrs.  Bedford- Fenwick,  then  Miss  Manson, 
came  in  1881  that  the  old  , untrained  Sisters  and  nurses 
were  gradually  weeded  out  and  the  training  lengthened 
to  three  years. 

A  tremendous  change?  YeS;  greater  than  you 
can  imagine.  I  have  really  no  words  in  which  to  de- 
scribe the  state  the  hospital  was  in  when  I  came  as 
probationer,  and  if  I  had,  you  would  say  the  account 
was  not  fit  for  publication.  When  first  I  became  Sis- 
ter I  often  stayed  up  all  night  because  there  was  no 
one  to  look  after  my  patients  but  an  old  woman  prob- 
ably both  drunk  and  disreputable,  and  unable  either 
to  read  or  write. 

It  was  many  years  before  the  nursing  staff  in  gen- 
eral was  treated  with  anything  approaching 
respect.^ 

>  Sister  "  Casualty,"  in  "  League  News,"  Journal  of  St. 
Bartholomew's  Nurses'  League,  No.  5,  May,  1902.  p.  134 
«t  seq. 


CHAPTER  VII. 

THE  TREATY  OF  GENEVA  AND  THE  RED  CROSS. 

IN  reading  of  war  nursing  and  the  relief  of  the 
wounded  to-day,  the  activity  of  the  Red 
Cross  w^ould  loom  large  on  every  page,  mitigating 
and  repairing  the  horrors  and  brutalities  of  battle 
between  man  and  his  fellows ;  but  no  such  benefi- 
cent agency  existed  at  the  time  of  the  Crimean 
War.  This  was  one  of  the  last  great  wars  to  be 
carried  on  before  a  general  humanity  organised 
its  counter-army  of  relief.  Miss  Nightingale  and 
her  aides  had  to  cover  as  best  they  might  the 
whole  ground  now  cared  for  by  a  highly  systema- 
tised  network  of  medical,  surgical,  nursing,  and 
general  relief  service. 

In  whose  mind  had  the  thought  of  neutrality 
for  the  wounded  first  arisen  ?  Who  shall  say  how 
far  back  it  had  been  germinating?  There  was  Hal- 
dora,  of  Iceland,  who  lived  about  the  year  looo — "  a 
fair  woman,  and  she  had  a  good  temper" ;  she  was 
also  a  woman  of  great  intellectual  faculty,  and 
she  had  "a  lovely  mind."  After  a  deadly  battle, 
Haldora  had  said  to  the  women  of  her  house,  "  Let 
us  go  and  dress  the  wounds  of  the  warriors,  be 

312 


Treaty  of  Geneva  and  Red  Cross     313 

they  friends  or  foes."  She  herself  sought  the 
wounded  in  every  direction,  and  came  upon  the 
chieftain  of  the  enemy,  prostrate  with  a  ghastly 
wound  of  the  chest  through  which  his  lungs  could 
be  seen.  Haldora  dressed  the  wound,  stayed  by 
him  all  day,  nursed  him  assiduously,  and  he  lived, 
owing  his  life  to  her.  "This  happened,"  says 
Mrs.  Norrie,  "some  years  before  the  people  of  the 
North  adopted  Christianity,  and  it  was  not  until 
1863  that  the  treaty  of  Geneva  saw  the  light. "^ 
Again,  in  the  war  of  1813,  three  women  of  Frank- 
fort had  issued  a  call  which  brought  together  all 
the  women  of  the  city  in  a  union  to  provide  care 
for  the  wounded  without  distinction  between 
friends  and  enemies.  This  "  Frauenverein  "  antic- 
ipated the  spirit  of  the  Red  Cross. 

M.  Moynier  instances  the  work  of  the  Knights 
Hospitallers  as  a  sort  of  Red  Cross  work,  and  men- 
tions the  creation  of  a  medical  service  attached  to 
armies  as  having  been  regarded,  through  the  past 
three  centuries,  as  all  that  could  be  required  for 
the  emergencies  of  war.^ 

The  origin  of  modern  army  medical  service  is 
ascribed  to  Isabella,  Queen  of  Spain,  who  in  the 
wars  of  her  time  founded  tent  hospitals  for  the 
soldiers  and  supplied  them  with  medicines,  appli- 
ances, and  attendants  to  assist  the  physicians. 

1  "Nursing  in  Denmark,"  by  Charlotte  Gordon  Norrie, 
American  Journal  of  Nursing  Dec.,  1900,  pp.  183-184. 

2  The  Red  Cross:  Its  Past  and  its  Future,  by  Gustav  Moy- 
nier, President  of  the  International  Red  Cross  Committee. 
London,  Paris,  New  York,  1883,  p.  12. 


314  A  History  of  Nursing 

Until  the  time  of  Aliss  Nightingale's  overthrow 
of  army  traditions  society  had  rested  satisfied  in 
the  belief  that  no  more  could  be  done  for  the 
soldier  in  time  of  war.^ 

The  modem  organisation  known  as  the  Red 
Cross  owes  its  inception  to  Henri  Dunant,  a  Swiss 
gentleman  who,  while  travelling  in  Italy  in  1859, 
visited  the  battle-field  after  the  bloody  day  of  Sol- 
ferino.  Nearly  forty  thousand  men  had  been  lost 
in  this  battle,  and  the  wounded  were  widely  distrib- 
uted over  an  extensive  region.  So  inadequate  was 
the  relief,  although  the  inhabitants  of  neighbour- 
ing towns  did  all  in  their  power,  that  the  wounded 
and  dead  alike  lay  on  the  ground  for  days  un- 
tended,  and  many  who  might  have  been  saved 
died  of  neglect.  The  scenes  of  needless  suffering 
made  so  deep  an  impression  on  Dunant,  who  joined 
as  a  volunteer  in  the  melancholy  task  of  attempt- 
ing to  succour  a  few  at  least  of  the  wounded,  that 
a  little  later  he  wrote  a  description  of  all  that  he 
had  seen,  under  the  title  A  Souvenir  of  Solferino. 
in  a  pamphlet  that  created  a  profound  and  general 
impression.  In  it  he  strongly  advocated  the  or- 
ganisation of  some  sufficient  way  of  caring  for  the 
wounded  after  battle,  and  he  followed  up  the  im- 
pression his  publication  had  made  by  lecturing, 
and  bringing  the  subject  in  every  way  before  the 
public  conscience.     In  Geneva  he  secured  the  sup- 

»  At  a  meeting  of  the  Red  Cross  societies  of  the  world  held 
in  London  in  June,  1907,  unanimous  resolutions  were  passed 
honouring  Miss  Nightingale  and  declaring  that  her  work  was 
the  beginning  of  the  Red  Cross  activities. 


I 


Treaty  of  Geneva  and  Red  Cross     315 

port  of  M.  Gustav  Moynier,  the  president  of  the 
Society  of  PubHc  Utility  and  a  citizen  of  rare 
quaHties,  who  called  the  society  together  to  con- 
sider "a  proposition  relative  to  the  formation  of 
permanent  societies  for  the  relief  of  wounded  sol- 
diers." On  the  9th  of  February,  1863,  Dunant 
appeared  before  the  Society  of  Public  Utility, 
and  set  forth  his  plan,  which  was,  in  brief,  to  have 
organised  in  each  country  central  associations 
which  should  be  responsible  for  the  administra- 
tion of  relief  in  war,  and  which,  while  independent 
of  each  other,  should  each  be  formed  under  the 
protection  of  its  own  country's  laws,  all  being 
affiliated  together  in  an  international  voluntary 
bond.  The  plan  met  with  the  warmest  support 
of  the  hearers,  who  were  men  representing  the 
highest  and  finest  types  of  civilisation,  and  the 
Society  of  Public  Utility  took  action  by  appoint- 
ing a  committee  to  take  the  proper  steps  toward 
organisation.  As  the  outcome  of  the  doings  of 
this  committee,  an  international  congress  was 
called  to  meet  in  Geneva  in  October,  1863,  to  con- 
sider how  the  horrors  of  war  might  be  lessened 
for  the  wounded  and  the  sick.  The  official  repre- 
sentatives of  fourteen  nations  attended  the  con- 
gress, which  was  in  session  for  four  days.  There 
were  also  present  the  representatives  of  benevo- 
lent associations,  notably  the  order  of  St.  John  of 
Jerusalem.  All  the  chief  nations  of  Europe,  ex- 
cept Russia,  sent  delegates,  but  the  United  States, 
then  distracted  with  its  own  civil  war,  made  no 


3i6  A  History  of  Nursing 

response  to  the  call.  It  was  agreed  by  the  dele- 
gates that  a  second  conference  should  take  place 
in  Geneva  in  the  next  year,  1864,  and  that  a  formal 
agreement  or  treaty  should  then  be  presented, 
providing  for  the  neutrality  of  hospitals  on  the 
fields  of  battle.  At  this  second  meeting  the 
famous  articles  known  as  the  Geneva  conven- 
tion or  treaty  were  adopted;  they  are  nine  in 
all,  but  a  section  of  the  last,  referring  only  to 
the  details  of  procedure,  is  sometimes  printed  as 
a  tenth.  1  They  provided  for  the  neutrality  of  all 
ambulances  and  hospitals  and  their  supplies,  equip- 
ment, and  personnel,  and  adopted  a  flag,  badge, 
and  uniform  to  distinguish  and  protect  them.  The 
insignia  agreed  upon  for  the  new  society  was  a 
modification  of  the  Swiss  colours,  which  show  a 
white  cross  on  a  red  field.  It  was  decided  to  re- 
verse the  colours,  and  thus  the  red  cross  on 
a  white  ground,  to  be  placed  conspicuously  on 
ambulances,  equipments,  and  accoutrements  of 
hospital  service,  and  to  be  worn  upon  the  arm  of 
aides, — the  brassard, — was  adopted  as  the  badge 
of  the  society,  which  was  henceforth  to  be  known 
in  every  country  as  the  "  Red  Cross."  It  is  inter- 
esting to  recall  here  that  many  centuries  ago  the 
Knights  of  St.  John  of  Jerusalem  in  carrying  on 
a  work  of  similar  purpose  adopted  the  same  in- 

>  Their  full  text  is  given  in  the  History  of  the  Red  Cross, 
the  Treaty  of  Geneva,  and  its  Adoption  by  the  United  States 
(published  by  the  American  Association  of  the  Red  Cross; 
printed  by  the  Government  Printing  Office,  1883),  pp.5i-53t 
and  in  Moynier,  op.  cit.,^-p.  177-179. 


Treaty  of  Geneva  and  Red  Cross      3^7 

signia  and  were  known  as  * '  Knights  of  the  Red 
Cross." 

Free  and  Hberal  Switzerland  is  the  only  country 
internationally  organised,  and  is  the  head  and 
centre  of  international  Red  Cross  relations.  Its 
standing  committee,  of  which  M.  Moynier  became 
president,  is  a  clearing-house  for  Red  Cross  work 
all  over  the  world.  The  committee  stimulated 
organisation  in  countries  not  yet  in  the  bond,  dis- 
seminated information,  promoted  research  for  the 
improvement  of  methods  and  equipment,  and  in 
general  guided  the  whole  network  of  affiliation. 
Switzerland  and  France  were  the  first  nations  to 
sign  the  treaty;  others  held  back  a  little  at  first, 
but  soon  ten  others  signed,  and  a  little  later  all  of 
those  present.  So  great  was  the  popular  approval 
that,  at  the  time  when  only  ten  signatures  had 
been  affixed  to  the  treaty,  there  were  already 
twenty-five  central  committees  organised  in  as 
many  countries.^ 

The  four  leading  principles  on  which  the  found- 
ers of  the  Geneva  treaty  based  their  plans  were, 
as  has  been  w^ell  explained  by  IMiss  Clara  Barton 
(for  many  years  the  president  of  the  American 
society) — i.  Centralisation:  Efficiency  of  relief 
in  time  of  war  depends  on  unity  of  direction; 
therefore  each  country  must  have  its  central  com- 
mission or  body.     2.     Preparation:  To  be  ready 

1  The  countries  that  first  signed  were  Italy,  Baden,  Bel- 
gium, Denmark,  Holland,  Spain,  Portugal,  France,  Prussia, 
Saxony,  Wiirtemburg,  and  Switzerland. 


31 8  A  History  of  Nursing 

for  service  in  war  or  other  calamity  incessant  prep- 
aration must  be  carried  on  in  times  of  peace.  3. 
Impartiality:  National  societies  are  not  always 
in  a  position  to  reach  their  own  soldiers ;  therefore 
all  societies  must  equally  be  ready  to  rescue  friends 
or  foes.  4.  Solidarity:  Neutral  nations  must  be 
enabled,  through  the  central  committee,  to  fur- 
nish aid  to  belligerents  without  infraction  of  the 
non-interference  to  which  their  governments  may 
be  pledged. 

From  the  outset  it  was  recognised  as  being  of 
the  first  importance  that  the  national  societies 
should  have  the  definite  recognition  of  their  home 
governments,  as  without  this  all  volunteer  efforts 
in  time  of  war  must  be  crippled  and  inadequate. 
As  a  consequence  the  conference  of  1863  recom- 
mended all  central  committees  to  put  themselves 
in  relation  with  their  various  governments.  Nor 
were  the  rulers  of  Europe  slow  to  see  the  import- 
ance of  official  recognition  and  co-ordination  be- 
tween the  executive  and  military  departments 
and  this  powerful  volunteer  army. 

Thus  were  brought  into  existence  the  now  world- 
wide ramifications  which  have  made  it  possible 
for  organised  mercy,  pity,  and  common-sense  to 
bring  a  counter-influence  to  bear  on  all  the  various 
and  conflicting  problems  of  war.  Rescue,  repair, 
even  prevention  and  constructive  force  have  risen 
in  opposition  to  destructive  elements,  and  possibly 
at  some  time  in  the  future  the  ultimate  extinction 
of  war  from  the  earth  will  be  dated  from  the  day 


Treaty  of  Geneva  and  Red  Cross      3^9 

when  Henry  Dunant  wrote  his  appeal  to  the  peo- 
ple. The  natural,  even  if  unconscious,  influence 
of  such  an  organisation  as  the  Red  Cross  is  first 
to  mitigate  and  then  to  abolish  international  cru- 
elty and  murder.  But  that,  even  from  the  outset, 
the  abolition  of  war  as  an  ultimate  possibility  was 
present  in  the  minds  of  the  noble  group  of  men 
who  called  the  international  conference  is  clear 
from  the  words  that  were  spoken  in  that  first  con- 
vention— "  The  Red  Cross  shall  teach  war  to  make 
war  upon  itself."  Nursing  was  recognised  in  the 
resolution  passed:  "On  the  demand,  or  with  the 
concurrence,  of  the  military  authority  the  commit- 
tee shall  send  volunteer  nurses  to  the  field  of 
battle,  where  they  will  be  under  the  direction  of 
military  chiefs." 

The  plans  and  principles  of  the  Red  Cross  were 
energetically  propagated  by  the  International 
Committee,  and  met  with  a  warm  response.  A 
deep  and  abiding  enthusiasm  spread  from  country 
to  country  and  from  city  to  town.  Local  com- 
mittees were  formed  with  extraordinary  rapidity, 
and  the  work  of  preparation  for  succour  and  relief 
went  on  all  over  Europe  without  remission.  Ger- 
many especially  excelled  in  organisation,  and 
advanced  rapidly  to  an  astonishing  perfection  of 
service.  To  stimulate  and  inform  the  public,  ex- 
hibitions were  held  in  different  countries,  at  which 
the  latest  and  best  in  equipment  and  outfitting 
was  shown,  and,  developing  from  these  exhibits, 
permanent  Red  Cross  museums  have  been  estab- 


320  A  History  of  Nursing 

lished  in  several  cities,    such  as   Stockholm,    St. 
Petersburg,  Carlsruhe,  Moscow,  and  Paris. 

The  Red  Cross  societies  of  the  continent  of 
Europe  have  taken  a  prominent  and  energetic 
part  in  the  development  of  nursing  on  a  secular  and 
systematic  basis.  As  they  undertook  to  be  re- 
sponsible for  service  in  war,  it  became  necessary 
for  them  to  train  nurses,  for  the  existing  mother- 
houses  of  religious  orders  and  the  ill-taught  per- 
sonnel of  the  public  hospitals  offered  no  reserve  of 
sufficient  proportions  or  adaptability.  In  order 
to  train  nurses,  it  was  necessary  to  command  hos- 
pitals; hence,  one  of  the  first  and  most  arduous 
tasks  of  the  local  societies  was  to  collect  funds  and 
build  hospitals  which  should  be  under  their  own 
management  and  be  capable  of  being  utilised  as 
training  centres.  These  institutions,  therefore, 
performed  a  double  duty — to  the  community  in 
which  the  hospital  was  located,  and  to  the  country 
at  large.  This  initiated  a  woman's  movement  of 
vast  proportions,  for,  while  men  and  women,  in  a 
large  measure,  worked  side  by  side  on  terms  of 
harmony  and  equality  under  the  Red  Cross,  it 
nevertheless  followed  from  the  very  nature  of  the 
details  that  women  often  took  a  foremost  and 
major  share  in  the  responsibility.  They  not  only 
raised  money,  gathered  the  supplies,  built,  often 
administered  and  helped  to  support  the  hospitals, 
but  also  went  into  them  as  nurses.  Women's 
relief  societies  developed  numerously  as  auxil- 
iaries, and  became  thoroughly  organised,  especially 


Treaty  of  Geneva  and  Red  Cross      321 

in  Germany.  The  general  line  on  which  the  nurs- 
ing personnel  of  the  Red  Cross  societies  was  devel- 
oped among  the  nations  of  the  continent  was  then 
as  follows :  A  central  or  local  hospital,  managed 
by  the  local  society,  and  at  least  partly  supported 
by  revenue  from  pay  patients,  became  the  nucleus 
or  motherhouse  for  a  nursing  staff.  Women  were 
received  to  be  trained  as  nurses,  with  the  under- 
standing that  they  would  contract  themselves  for 
at  least  a  certain  given  period,  mutually  renew- 
able, and  possibly  lasting  for  the  nurse's  lifetime. 
While  this  mutual  contract  lasted,  the  nurse 
was  practically  a  part  and  parcel  of  the  general 
equipment  of  the  Red  Cross  society.  In  time  of 
war  she  was  ready  for  military  service,  her  place 
in  the  hospital  being,  very  possibly,  filled  for  the 
time  being  by  a  lay  volunteer.  In  time  of  peace 
she  was  employed  to  the  best  advantage  of  the 
society  with  which  she  was  united ;  thus  she  might 
be  sent  to  private  duty,  her  earnings  coming  into 
the  society  treasury,  or  to  work  in  other  hospitals, 
which  often  found  it  easier  and  cheaper  to  con- 
tract with  a  nursing  association  for  a  given  staff 
of  nurses  than  to  train  and  be  responsible  for  their 
own.  If  she  remained  permanently  with  the  soci- 
ety, she  was  promised  support  and  care  in  her  old 
age  but,  if  she  finally  left  it  for  an  independent 
life  she  gave  up  all  claim  on  its  employment  of 
or  responsibility  for  her.  Her  conditions,  in 
short,  were  closely  modelled  after  those  of  military 
service.       Her    life     was    one    of    the    strictest 

VOL.  II. — 21. 


322  A  History  of  Nursing 

discipline;  she   was  a   soldier   of    a    great  relief 
army. 

As  a  social  movement  and  as  an  emancipatory- 
factor  the  Red  Cross  nursing  movement  of  the  con- 
tinent was  of  an  importance  that  is  hardly  to  be 
over-estimated.  It  was  distinctly  a  long  step 
forward  toward  social  and  economic  equality, 
though  by  a  hard  road.  Caste  lines  received  a 
severe  blow  from  the  extension  of  Red  Cross  work, 
and  "confessional"  exclusiveness  was  even  more 
seriously  damaged,  for  the  necessity  of  keeping 
their  quota  of  nurses  filled  compelled  the  Red  Cross 
to  disregard  sectarian  religious  prejudices.  An 
intellectal  freedom  never  enjoyed  by  the  deacon- 
esses was  thus  possible  for  the  ntirses  of  the  Red 
Cross  (as  they  were  always  called,  so  long  as  they 
remained  in  the  employ  of  a  Red  Cross  society), 
and  a  freer  social  element  gave  a  more  normal 
atmosphere  to  their  communities.  Most  import- 
ant of  all,  for  evolutionary  purposes,  was  the  fact 
that  it  was  far  easier  to  terminate  the  contract  and 
honourably  leave  the  Red  Cross  service  to  take 
up  self-support  on  independent  lines  than  it  was 
to  leave  the  deaconesses'  Motherhouse,  for  a  cer- 
tain sense  of  public  decorum  (or  narrowness)  was 
shocked  in  the  latter  case  but  not  in  the  former. 
Indeed,  the  very  conditions  of  Red  Cross  service 
almost  compelled  a  steady  exodus  of  nurses  from 
its  control ;  for,  while  on  the  one  hand  it  was  im- 
portant and  necessary  to  train  as  large  a  number 
as  possible,  on  the  other  hand  it  rapidly  became 


Treaty  of  Geneva  and  Red  Cross      323 

a  financial  impossibility  to  support  all  their  nurses 
decently  in  old  age  and  sickness,  because  of  the 
continued  obligation  to  hold  funds  and  resources 
of  all  kinds  in  readiness  for  the  possible  demands 
of  war  time.  Important  as  the  phase  represented 
by  the  deaconesses'  movement  had  been  as  a  step 
toward  democracy  and  education,  that  of  the  Red 
Cross  went  far  beyond  it  in  secularisation  of  the 
nurse's  calling  and  as  a  preparation  for  still  further 
advances  in  the  definition  of  her  status  and  in  her 
training. 

On  the  technical  side  of  nursing  the  Red  Cross 
has  been  a  factor  both  for  good  and  for  poor  stand- 
ards. Its  nurses  in  Continental  countries  have 
often  been  well  and  carefully  trained.  In  some 
countries  the  Red  Cross  nurses,  as  they  are  called, 
stand  in  the  very  front  rank  for  ability  and  thor- 
ough preparation.  On  the  other  hand,  the  very 
nature  of  the  Red  Cross  societies  encourages  vol- 
unteer service,  and  while  this  arm  of  the  service 
can  and  does  do  magnificent  work  in  general  relief, 
the  same  cannot  be  said  of  it  in  nursing,  which  a 
superficial  training  must  always  render  incom- 
petent. Lay  workers  of  all  social  grades,  from 
attendants  to  princesses,  have  had  a  passion  for 
so-called  army  nursing,  which  has  promoted  short 
courses  in  bandaging  and  in  first  aid,  often  hastily 
given  in  the  presence  of  some  emergency.  This 
has  been  especially  true  of  those  countries  where 
the  Red  Cross  has  been  least  thoroughly  organ- 
ised and  has  most  retained  a  volunteer  character ; 


324  A  History  of  Nursing 

but  this  criticism  is  far  less,  or  even  not  at  all, 
applicable  in  those  countries  where  the  Red 
Cross  system  has  been  most  seriously  looked  upon 
as  an  important  arm  of  the  public  service. 

In  countries  where  the  ancient  nursing  orders  had 
thrown  out  modem  offshoots,  as  in  Austria,  where 
the  Teutonic  Knights  already  had  quite  an  active 
role  in  the  relief  of  the  wounded  in  war  time,  the 
Red  Cross,  not  without  the  exercise  of  considerable 
diplomac}^  framed  harmonious  working  agree- 
ments with  them.  The  order  of  St.  John  of  Jeru- 
salem, whose  modem  branches  in  Germany,  Italy, 
and  elsewhere  had  grown  aristocratic,  and  prac- 
tised a  somewhat  academic  philanthropy,  was 
stimulated  to  some  modification  of  its  old-time 
ways  by  the  vigorous,  democratic,  enthusiastic 
young  society  of  the  Red  Cross,  and  in  some  coun- 
tries co-operation  between  the  two  developed  to 
a  satisfactory^  degree,  while  in  others,  where  church 
lines  and  hereditary  titles  are  too  exclusive, 
they  have  not  united,  but  recognise  each  other 
amicably.^ 

The  first  great  test  of  the  Red  Cross  organisa- 
tion came  with  the  war  of  187 1,  and  was  trium- 
phantly met.  ]\Iiss  Clara  Barton,  who  afterwards 
established  the  work  in  the  United  States,  was 
privileged  to  accompany  the  Swiss  committee 
through  the  war  of  187 1,  and  \\Tote  as  follows  of 
her  experience  there,  comparing  it  with  her  recol- 
lections of  the  Cix-il  War  in  America,  when  she  had 
>  The  Red  Cross,  Gustav  Moynier,  pp.  39-40. 


Treaty  of  Geneva  and  Red  Cross     325 

also  given  active  volunteer  service  on  the  battle- 
field, and  had  seen  untold  horrors : 

As  I  journeyed  on,  and  saw  the  work  of  the  Red 
Cross  societies  in  the  field,  accomplishing  in  four 
months  under  their  systematic  organisation  what 
we  failed  to  accomplish  in  four  years  without  it, — no 
mistakes,  no  needless  suffering,  no  starving,  no  lack 
of  care,  no  waste,  no  confusion,  but  order,  plenty, 
cleanliness,  and  comfort  wherever  that  little  flag  made 
its  way — as  I  saw  all  this,  and  joined  and  worked  in 
it,  I  said  to  myself,  *'If  I  live  to  return  to  my  country 
I  will  try  to  make  our  people  understand  the  Red 
Cross  and  that  treaty. ' '  ' 

»  History  of  the  Red  Cross,  p.  59. 


CHAPTER  VIII. 

THE  DEVELOPMENT  OF  NURSING  IN  AMERICA. 

WHEN  the  pilgrim  fathers  and  mothers  landed 
on  Plymouth  rock,  bringing  their  Spar- 
tan domestic  customs  with  them,  they  did  not 
introduce  the  art  of  nursing  into  the  New  World, 
for,  long  before,  as  we  have  seen,  the  Jesuit  Fa- 
thers of  France  had  pioneered  in  medicine  and  the 
Catholic  Sisters  had  established  their  mission  hos- 
pitals. Even  before  that  time  the  Indians  had 
practised  their  rude  methods  of  medical  and  sur- 
gical treatment,  and  in  the  very  dawn  of  history 
the  Aztecs  and  Incas  had  built  their  hospitals 
and  taken  care  of  their  sick. 

The  organised  system  of  nursing  now  prevailing 
in  the  United  States  dates,  it  may  be  said,  from 
187 1,  but,  as  in  England,  it  was  preceded  by  many 
tentative  efforts  that  are  historically  important 
and  significant.  Hospitals  are  the  cradles  of  nurs- 
ing, and  we  may  properly  turn  first  to  the  oldest 
of  our  hospitals — the  Philadelphia,  first  known  as 
the  Philadelphia  almshouse  and  later  as  "  Block- 
ley,"  and  to  Belle\'ue  in   New  York  City.     The 

326 


Development  of  Nursing  in  America  327 

latter,  Dr.  Carlisle  tells  us,i  may  lay  claim  to  be  the 
oldest  hospital  now  in  existence  in  the  United 
States.  Like  many  other  now  great  institutions, 
its  origin  was  of  the  humblest.  Its  genealogy 
runs  back  into  the  city  of  Amsterdam,  and  to  the 
times  when  the  poor  were  supported  by  the  church 
in  a  modest  building  which  served  as  a  poorhouse. 
This  charity,  and  a  little  hospital  which  was  built 
by  the  West  India  Company  at  the  suggestion 
of  its  surgeon,  were  the  two  roots  from  which 
developed  the  city  hospital  of  Bellevue.  The 
company's  hospital  dates  back  to  the  month  of 
December  in  1658,  when  the  village  of  New  Am- 
sterdam only  numbered  a  thousand  inhabitants, 
and  was  the  first  one  built  on  United  States  soil. 
In  1680  the  "old  hospital"  was  sold  and  a  better 
building  provided,  and  still  later  the  church  funds 
for  the  poor  were  increased  by  an  addition  from 
the  city  fathers.  In  1736  a  new  building  was 
fitted  up  to  serve  as  a  "  Publick  Workhouse  and 
House  of  Correction  of  New  York."  There  were 
rooms  for  various  kinds  of  labour,  spinning,  etc.  ; 
quarters  for  the  family  of  the  keeper,  and  rooms 
for  an  infirmary  of  six  beds.  This  building,  the 
immediate  ancestor  of  Bellevue,  stood  where  the 
city  hall  now  stands.  As  time  went  on  it  was  sev- 
eral times  rebuilt  and  enlarged.  The  present  site  of 
Bellevue  on  the  East  River,  with  a  house  which 

»  An  Account  of  Bellevue  Hospital,  New  York,  by  Robert 
Carlisle,  M.D.,  published  by  the  Society  of  Alumni  of  Belle- 
vue Hospital,  New  York,  1893,   p.  i. 


328  A  History  of  Nursing 

became  the  nucleus  of  the  first  Bellevue  hospital, 
was  purchased  by  the  city  with  some  haste  in 
1794,  a  threatened  epidemic  of  yellow  fever  hav- 
ing caused  the  city  authorities  to  prepare  a  "pest- 
house"  for  the  emergency.  The  principal  building 
on  the  domain  was  a  two-story  and  garret  house, 
and  the  estate,  which  was  very  beautiful,  had  been 
named  by  the  owners  Bellevue. 

For  a  number  of  years  it  was  used  only  when 
there  w^as  yellow  fever  in  the  city,  being  for  this 
purpose  placed  under  the  management  of  the 
Health  Board,  but  in  181 1  more  ground  was 
bought  around  it,  and  a  new  almshouse  built.  The 
corner-stone  was  laid  July  29,  181 1.  Delayed  by 
the  War  of  1 8 1 2 ,  it  was  only  finished  and  opened 
in  April,  1816;  with  the  almshouse  quarters,  a 
penitentiary,  together  with  wards  for  the  sick  and 
the  insane  all  in  the  same  building  with  the  rooms 
for  the  resident  physician,  the  warden,  and  the 
attendants.  The  old  grey  stone  structure  fronting 
the  broad  arm  of  the  sea  called  the  East  River 
looked  dignified  and  interesting  with  its  extensive 
green  sweep  of  lawn,  adorned  with  a  few  fine  old 
trees,  but  it  has  had  a  terrible  history.  The  pau- 
pers numbered  from  sixteen  hundred  to  two  thou- 
sand, and  among  them  were  often  as  many  as  two 
hundred  sick.  Epidemics,  arising  from  unsanitary 
conditions  and  overcrowding,  were  frequent  and 
severe.  Typhus  fever,  the  sinister  companion  of 
filth  and  misery,  now  all  but  unknown  in  America^ 
was  then  common.     The  physicians  were  cruelly 


tn 


3 


-5  <  _ 

C      3     >- 

SI! 


~  <1    o 

^  2  *^ 

^  -5 


C  2 
'5 


Development  of  Nursing  in  America  329 

overworked,  for  only  three  were  assigned  to  super- 
vise the  whole  household,  both  sick  and  well.  The 
nurses  (so  called)  were  detailed  from  the  prison, 
and  were  appointed  in  the  proportion  of  one  for 
ten  or  twenty  patients.  Political  jobbery  was  rife, 
and  the  positions  in  the  hospital  were  given  to 
political  henchmen  without  the  slightest  regard 
to  their  unfitness  for  their  trust.  During  many 
years  nothing  but  horrors  existed  at  Bellevue.  In 
1826  Dr.  Wood  complained  that  the  overcrowding 
was  such  that  men  and  women  ill  with  small-pox 
had  to  be  kept  in  the  same  ward.  In  1832  there 
was  a  frightful  epidemic  of  cholera,  and  the  dead 
lay  so  thick  on  the  floors  that  the  physicians  had 
to  step  over  their  bodies  in  making  their  rounds. 
In  1837  the  conditions  in  general  were  such  as  to 
shock  even  the  aldermen  themselves,  and  a  com- 
mittee of  investigation  was  appointed.  The  only 
part  of  the  whole  building  which  was  found  to  be 
clean  and  in  good  order  was  the  female  depart- 
ment of  the  almshouse  division,  which  furnished 
"a  silent  rebuke"  in  its  contrast  to  the  rest.^ 

The  investigating  committee  reported  that  ''the 
condition  of  Bellevue  hospital  was  such  as  to  ex- 
cite the  most  poignant  sympathy  for  its  neglected 
inmates." 

Among  the  specifications  they  gave  were ;  filth, 

no  ventilation,   no  clothing,  patients  with  high 

fever  lying  naked  in  bed  with  only  coarse  blankets 

to  cover  them,  wards  overcrowded,  jail  fever  rife, 

«  Carlisle,  op.  cit.  p.  37. 


330  A  History  of  Nursing 

no  supplies,  putrefaction  and  vermin.  It  was 
reported,  furthermore,  that  the  resident  physician 
with  his  students  (two  only  excepted) ,  the  matron, 
and  the  nurses  had  left  the  building.  ^ 

Dr.  Benjamin  Ogden,  a  former  resident  whose 
administration  had  been  upright,  was  asked  to 
return,  and  did  so,  and  succeeded  in  effecting  some 
reforms  in  discipline  and  in  solving  the  problem 
of  supplies. 

As  a  result  of  this  investigation  a  redistribu- 
tion of  the  inmates  was  decided  upon,  and,  in 
1836,  the  male  and  female  prisoners  were  removed ; 
in  1837  the  small-pox  cases  were  provided  for  in  an 
institution  on  Blackwell's  Island,  and  thither  also 
the  insane  patients  were  removed  in  1839 ;  but  the 
almshouse  and  hospital  remained  together  undei 
the  one  roof  until  1848,  when  they  were  separated, 
and  the  stone  pile  of  Bellevue  began  its  career  as 
a  hospital.  This  final  step  in  reform  was  hastened 
by  some  forcible  letters  that  had  appeared  in  the 
Evening  Post  pointing  out  the  maladministration 
and  the  high  death-rate  (about  25  per  cent.)  of 
Bellevue,  and  which  were  supposed  to  have  been 
written  by  Dr.  Griscom  of  the  Health  Department.  2 
This  new  departure  was  also  consistently  sup- 
ported by  the  most  distinguished  members  of  the 
medical  profession,  many  of  whom,  especially  Dr. 
J.  R.  Wood,  had  urged  a  change  in  the  manner  of 

J  Carlisle,  op.  cit,  p.  39. 

2  Observations  on  the  medical  organisation  of  the  hospitals 
at  Bellevue  and  Blackwell's  Island,  Oct.  30,  Nov.  i,  5,  and 
6,1845. 


Development  of  Nursing  in  America  33 ^ 

making  medical  appointments  to  the  hospital. 
Heretofore  these,  like  the  other  offices,  had  been 
used  as  political  rewards,  but  in  1847  a  new  era 
began  with  the  creation  of  a  Medical  Board. 

Nor  had  the  profession  been  altogether  indif- 
ferent to  the  disgrace  attaching  to  the  system  of 
nursing.  At  the  time  of  the  separation  of  the 
almshouse,  and  previously,  when  the  Medical 
Board  was  appointed,  the  physicians  had  pro- 
tested against  the  internal  conditions.  In  1857 
they  had  objected  to  the  employment  of  prisoners 
and  paupers  as  nurses,  and  some  had  asked  that 
Sisters  of  Charity  be  placed  in  the  wards.* 

An  interesting  bit  of  negative  testimony  as  to 
the  status  of  nursing  in  those  days  is  furnished  by 
an  article  written  in  1856,  describing  Bellevue 
hospital. 2  In  this  article  there  is  not  one  word 
about  the  nursing  or  the  care  of  the  patients. 

In  Philadelphia,  Blockley  also  began  as  an  alms- 
house* It  supported  and  employed  the  poor, 
received  orphans,  the  insane,  and  the  sick.^  Its 
nursing  history  is  equally  terrible  as  that  of 
Bellevue,  and  even  more  of  its  details  have  been 
recorded. 

»  A  Century  of  Nursing,  with  Hints  toward  the  Formation 
of  Training  Schools  for  Nurses.  G.  P.  Putnam's  Sons,  New 
York,  1876.     p.  14. 

2  "  History  and  Early  Organisation  of  Bellevue,"  A^.  Y. 
Journ.  of  Med.,  May,  1856,  p.  389. 

i  History  of  the  Philadelphia  Almshouse  and  Hospital  from 
the  Beginning  of  the  i8th  to  the  end  of  the  igth  Century, 
Compiled  and  published  by  Charles  Lawrence.  Philadelphia, 
1905. 


332  A  History  of  Nursing 

In  1729  the  Overseers  of  the  Poor  presented  a 
memorial  to  the  Assembly,  asking  for  a  grant  of 
money  for  dependent  persons,  for,  although  Phila- 
delphia had  had  an  almshouse  from  17 13,  it  was 
then,  and  always  had  been,  supported  by  the 
Friends  for  their  own  members  only.^  The  State 
granted  the  money  in  1730,  the  ground  was  bought 
and  the  erection  of  a  brick  building  was  begun  in 
the  following  year.  The  historian  of  Blockley 
says,  ''The  Philadelphia  hospital  is,  without 
doubt,  the  oldest  hospital  in  continuous  service 
in  this  country."  In  1766  the  paupers  numbered 
220,  and  in  1767  new  buildings  were  put  up.  Dur- 
ing the  occupation  of  Philadelphia  by  the  British 
troops  the  almshouse,  like  other  public  buildings, 
suffered  severely.  As  soon  as  the  troops  entered, 
the  command  was  sent  to  Blockley  to  turn  the 
inmates  out  to  make  room  for  them.  The  Board 
of  Guardians  had  the  courage  to  refuse  to  obey, 
but  to  no  avail,  for  the  patients  were  forcibly  put 
upon  the  streets  to  make  room  for  the  king's  sol- 
diers. 

In  1793  an  investigation  showing  "shock- 
ing abuses ' '  is  recorded ;  in  the  same  year  also  we 
come  upon  the  first  mention  of  nurses.  The  yel- 
low fever  raged,  and  it  was  "  impossible  to  procure 
suitable  nurses :  only  the  most  depraved  creatures 
could   be   hired";    .    .    .   "an    abandoned,  profli- 

1  It  was  in  the  old  Quaker  almshouse,  according  to  Agnes 
ReppHer,  the  brilliant  essayist  and  historian  of  Philadelphia, 
that  Evangeline  found  Gabriel. 


Development  of  Nursing  in  America  333 

gate  set  of  nurses  and  attendants,"  who  "rioted 
on  the  provisions  and  comforts  left  for  the  sick." 
All  the  work  of  the  house,  nursing  included,  was 
supposed  to  be  done  by  the  inmates,  and  there  is 
no  reason  to  believe  that  it  was  of  higher  grade 
than  that  at  Bellevue.  The  treatment  of  the  in- 
sane at  Blockley  was  especially  heartrending,  or, 
if  in  other  places  it  was  as  bad,  more  meagre  de- 
tails have  come  down  to  us.  Inconceivable  as  it 
sounds,  the  female  lunatics  were  under  the  charge 
of  a  male  keeper,  who,  assisted  by  two  male  pau- 
pers, slept  among  the  female  insane  and  took  the 
entire  management  of  the  violent  cases,  even  to 
bathing,  or  washing,  and  dressing  them.  Says 
the  history  quoted:  "Some  of  the  patients,  even 
in  their  madness,  shrunk  from  this  rude  handling 
and  raved  with  increased  fury  at  their  indecent 
exposure.  Revolting  to  decency  as  this  practice 
was,  it  was  not  without  difficulty,  and  only  by 
degrees,  abandoned. "^ 

It  was  also  the  custom  of  that  inhuman  institu- 
tionalism  to  permit  the  lowest  and  coarsest  of  the 
public  rabble  to  visit  the  wards  for  the  insane,  to 
laugh,  stare,  and  jeer  at  them  as  if  they  had  been 
wild  beasts  in  cages.  But  most  pitiful,  perhaps, 
of  all  was  their  suffering  from  cold,  for  in  those  days 
there  were  no  central  heating  plants,  and  appar- 
ently it  was  assumed  that  the  insane  were  insensi- 
ble to  degrees  of  temperature. 

Only  one  short  interregnum  of  peace  broke  the 

»  History  of  the  Philadelphia  Almshouse,  p.  172. 


334  A  History  of  Nursing 

long  and  distressing  reign  of  violence,  neglect,  and 
cruelty  in  Blockley. 

In  1832  there  was  a  severe  epidemic  of  cholera, 
and  the  attendants  demanded  more  wages.  To 
keep  them  to  their  duties  the  wages  were  increased, 
but  were  promptly  spent  for  liquor.  An  orgy  of 
intoxication  ensued,  and  the  helpers,  crazed  with 
drink,  fought  like  furies  over  the  beds  of  the  sick, 
or  lay  in  dnmken  stupour  beside  the  bodies  of  the 
dead.  So  complete  was  the  demoralisation  that 
the  guardians  applied  to  Bishop  Kendrick  for 
Sisters  of  Charity  from  Emmitsburg.  The  call 
was  responded  to  promptly;  indeed,  the  Sisters 
started  two  hours  after  the  summons  was  received. 
They  took  in  hand  the  whole  desperate  situation, 
at  once  restored  order  and  disseminated  about 
them  an  atmosphere  of  tranquillity  and  quiet 
energ}\  The  Sisters  remained  for  some  months, 
and  their  work  was  so  deeply  appreciated  by  the 
guardians  that  the  Committee  of  the  House,  in  a 
set  of  resolutions  commending  their  great  services, 
resolved  also  that  they  be  requested  to  remain 
permanently.  This,  however.  Father  Hickey, 
their  Superior,  negatived,  giving  his  reasons  at 
length.  He  did  not  consider  Blockley  the  depart- 
ment of  charity  in  which  the  Sisters  could  be  most 
usefully  employed,  so  the  guardians  were  obliged 
to  let  them  go,  with  glowing  tributes  which  may 
well  have  been  heartfelt.^ 

In  185 1  the  first  woman  physician  was  admitted 

>  History  of  the  Philadelphia  Almshouse,  p.  123. 


Development  of  Nursing  in  America  335 

to  the  service  in  Blockley,  but  it  is  not  evident  that 
she  was  allowed  to  do  anything  to  mitigate  con- 
ditions. In  1856  a  report  giving  most  horrible 
details  was  presented  by  Dr.  Campbell.  The  institu- 
tion now  comprised  small-pox  wards,  departments 
for  the  insane,  an  asylum  for  children,  a  lying-in 
department,  a  nursery,  a  hospital,  and  almshouses, 
wherein  were  congregated  the  blind,  the  lame,  and 
the  incurables.  All  these  departments  were  over- 
crowded, without  proper  classification,  and  en- 
tirely under  the  care  of  the  pauper  inmates,  or 
paid  attendants  taken  from  the  same  class.  The 
physical  conditions  of  the  place,  too,  owing  to  the 
fact  that  Blockley,  like  old  Bellevue,  had  always 
been  a  paradise  for  dishonest  contractors,  were  in 
a  shameful  state.  There  was  no  gas;  only  small 
hand-lamps  were  in  use.  There  was  no  laundry; 
the  clothing  was  given  out  to  a  small  army  of 
washerwomen.  In  the  hospital  departments  there 
was  not  a  water-closet,  and  only  one  bath-tub, 
that  one  being  on  the  men's  side.^  The  scandal  of 
the  nursing  continued  until  1884,  when  it  was 
reformed  under  Miss  Alice  Fisher,^  a  Nightingale 
nurse,  of  very  exceptional  talents  and  character, 
whose  achievements  at  Blockley  ranked  with  Miss 
Nightingale's  own  reforms. 

The  charter  of  the  Pennsylvania  hospital  was 

»  History  of  the  Philadelphia  Almshouse,  198-202. 

2  See  also  "  History  of  the  Foundation  and  Development  of 
the  First  Hospitals  in  the  United  States,  "  Amer.  Journ.  of 
Insanity,  vol.  xxiv.,  1867-68. 


33^  A  History  of  Nursing 

granted  in  the  year  1 7  5 1 .  This  was  the  first  hos- 
pital in  the  United  States  in  the  proper  sense  of 
the  word,  for  it  was  designed  solely  for  the  curative 
care  of  the  sick,  and  its  founders,  with  an  enlight- 
enment unusual  indeed  at  that  day,  placed  the 
insane  in  the  category  of  those  who  were  ill  and 
needed  treatment.  The  names  most  closely  con- 
nected with  the  inception  and  foundation  of  the 
Pennsylvania  hospital  are  the  honoured  ones  of 
Dr.  Thomas  Bond,  who  may  be  regarded  as  the 
creator  of  its  plan,  and  Benjamin  Franklin,  who 
did  most  to  realise  it.  The  project  of  establishing 
a  hospital  in  Philadelphia  had  been  talked  of  by 
the  Quakers  as  early  as  1709.  There  was  some 
slight  quarantine  provision  for  strangers,  but  this 
was  of  the  crudest  nature.  There  was  no  care  for 
the  insane,  who  were  spoken  of  in  the  petition  to 
the  Legislature  (largely  the  work  of  Franklin)  as 
''going  at  large,  a  terror  to  their  Neighbours,  who 
are  daily  apprehensive  of  the  Violences  they  may 
commit."  ^  The  opening  of  the  Pennsylvania 
hospital  inaugurated  an  era  of  caring  for  the  in- 
sane as  patients  suffering  from  mental  disease, 
and  giving  them  appropriate  treatment  instead 
of  treating  them  as  malefactors.  The  crudity 
of  earlier  care  can  be  gathered  from  a  record  dated 

1676:    "Jan Complayning   to   ye  Court  that 

his  son  Erick  is  bereft  of  his  naturall  senses  and 

1  History  of  the  Pennsylvania  Hospital  from  17 51  to  i8g§, 
by  Thomas  Morton,  M.D.  Authorised  by  the  Board  of  Man- 
agers.    Philadelphia,  1897.     P.  3. 


Development  of  Nursing  in  America  337 

is  turned  quyt  madd  and  yt:  he  being  a  poore 
man  is  not  able  to  maintaine  him:  Ordered; 
that  three  or  four  persons  be  hired  to  build  a  little 
block  house for  to  put  in  the  said  madman."  i 

None  other  of  our  hospitals  possesses  so  benign 
an  atmosphere  of  peaceful  seclusion,  historical 
association,  and  dignified  traditions  as  the  Penn- 
sylvania. Its  ample  grounds  and  quiet  situation 
enhance  this  feeling,  and  a  certain  old-world 
touch  is  given  by  the  pedestal  on  the  green  lawn, 
with  its  inscription  w^hich  recites  the  bestowal  of 
the  Charter  by  King  George  II. 

Its  early  years  were  checkered,  for  epidemics  of 
yellow  fever  and  cholera  were  frequent  and  terri- 
fying, and  times  of  war  brought  grave  troubles, 
Vv'hen  wounded  soldiers  and  Hessians  were  crowded 
into  it  without  notice  or  application  to  the  man- 
agers. There  is  no  mention  of  the  early  nursing 
arrangements  except  one  allusion  to  **  experienced 
and  trustworthy  persons,"  but  the  hospital  had  an 
interesting  experience  with  women  managers  in 
an  advisory  capacity.  In  1824  a  "Female  Board 
of  Assistants"  had  been  established,  and  increased 
in  numbers  the  following  year,  as  the  Hospital 
Board  thought  that  considerable  benefit  had  re- 
sulted to  the  hospital  from  their  disinterested  ser- 
vices. But  in  1827  a  collision  occurred  between 
the  "Female  Board"  and  the  Hospital  Board 
over   a   question   of    internal   order.     The  ladies 

1  History  of  the  Pennsylvania  Hospital  from,  17 51  to  iSpj, 
p.  4. 

VOL.    II. 22. 


338  A  History  of  Nursing 

"  expressed  their  disapproval  of  retaining  a  certain 
employee  in  the  hospital  in  any  capacity  what- 
ever." History  does  not  relate  who  this  employee 
was,  but  it  must  have  been  an  important  one — 
possibly  the  matron.  The  managers  refused  to 
accept  the  judgment  of  the  ladies,  and  they  re- 
signed in  a  body,  whereupon  the  managers  de- 
clared the  Female  Board  of  Assistants  abolished. 

Those  who  know  the  frequency  and  ease  with 
which  a  clever  but  unreliable  woman  can  deceive 
the  judgment  of  men,  and  who  also  know  the  su- 
perior type  of  woman  that  those  Quaker  dames  un- 
doubtedly presented,  cannot  doubt  that  they  were 
right  and  the  Hospital  Board  sadly  and  totally 
wrong.  In  1864  it  was  again  proposed  to  have 
lady  visitors  appointed  to  the  wards,  but  only 
such  harmless  duties  as  religious  reading  aloud 
and  the  like  were  allowed  to  them.  The  Pennsyl- 
vania hospital  established  a  training  school  in  1875. 

The  New  York  hospital,  the  next  in  age,  re- 
ceived its  charter  in  1 7  7 1 .  The  foundations  were 
laid  two  years  after,  but  before  being  finished  the 
structure  was  burned  to  the  ground,  and,  when 
finally  completed,  was  used  by  the  British  and 
Hessian  soldiery  for  a  barrack,  so  that  it  was  not 
able  to  receive  patients  until  January,  1791,  after 
it  had  recovered  from  the  disorganisations  of  war. 
The  New  York,  like  the  Pennsylvania,  being  a 
wealthy  hospital  in  which  the  most  prominent  and 
cultured  citizens  were  deeply  interested,  probably 
had  attendants  greatly  superior  in  grade  to  those 


Development  of  Nursing  in  America  339 

of  city  hospitals  like  Bellevue  and  Blockley.  We 
may  believe  that  they  were  the  best  that  could  be 
secured,  were  properly  housed  and  well  treated, 
and  held  to  a  conscientious  performance  of  their 
duties. 

The  distinction  of  having  made  the  first  attempt 
to  teach  its  nurse  attendants  belongs  to  the  New 
York  hospital;  andto  Dr.  Valentine  Seaman, 
one  of  its  medical  chiefs,  a  remarkably  broad- 
minded  man,  is  due  the  honour  of  having  conceived 
and  initiated  the  first  system  of  instruction  to 
nurses  on  the  American  continent.  His  services 
to  the  cause  of  education  are  commemorated  by  a 
letter  below  his  portrait  in  the  hospital,  in  which 
are  the  words :  "  In  1798  he  organised  in  the  New 
York  Hospital  the  first  regular  Training  School 
for  Nurses,  from  which  other  schools  have  since 
been  established  and  extended  their  blessings 
throughout  the  Community."  In  a  comparative 
study  of  the  first  efforts  at  nursing  reform  we  must 
consider  this  statement  as  too  sweeping,  in  so  far 
as  we  accept  Miss  Nightingale's  dictum  as  to  what 
constitutes  a  training  school,  but  there  is  no  doubt 
whatever  that  Dr.  Seaman  was,  in  many  of  his 
ideas,  far  ahead  of  his  time  in  liberality  of  view. 
In  connection  with  the  Maternity  department  of 
the  New  York  hospital  he  organised  a  course  of 
teaching,  and  gave  a  series  of  twenty -four  lectures, 
including  outlines  of  anatomy,  physiology,  and 
the  care  of  children,  the  three  concluding  ones 
of  which  have  been  preserved  in  a  small  volume 


340  A  History  of  Nursing 

called  The  Midwife's  Monitor  and  Mother's  Mirror, 
published  in  1800  by  Isaac  Collins.  His  ideas  on 
midwifery,  however,  would  meet  with  little  med- 
ical approbation  to-day,  for  he  regarded  midwives 
as  indispensable  and  necessary,  and  believed  they 
should  be  thoroughly  and  carefully  taught.  In 
the  roll  of  honour  in  nursing  reform  he  must  stand 
high  with  those  admirable  German  professors  of 
medicine  who  wrote  and  made  propaganda  in  the 
latter  part  of  the  eighteenth  century,  and  we  must 
always  regret  that  history  has  preserved  so  little 
record  of  his  actual  missionary  work. 

The  next  attempt  to  train  an  intelligent  nursing 
personnel  had  its  origin  in  Philadelphia  among 
the  Friends,  whose  predominance  in  that  city 
stamped  its  early  institutions  with  an  enlightened 
philanthropy.  As  early  as  1786  the  Philadelphia 
Dispensary  had  been  founded  for  the  medical, 
surgical,  and  obstetrical  service  of  the  poor  in 
their  homes,  and  the  originators  of  the  dispensary, 
in  making  their  public  appeals  for  support,  had 
pointed  out  the  need  for  such  public  service  with 
feeling  and  delicacy.  "There  are  many  [thus  ran 
the  circular]  who  cannot,  or  ought  not,  go  to  a 
hospital."  Such  persons,  they  contended,  could  be 
attended  in  their  homes  without  being  subjected 
to  the  pains  of  separating  from  their  families  ;  the 
care  given  them  would  be  at  less  cost  to  the  com- 
munity than  that  of  hospitals,  and  it  would  more- 
over be  possible  to  attend  to  them  in  a  quiet  and 
refined  way,  "consistent  with  those  noble  feelings 


\'alentine  Seaman,  M.D. 
Attending  Siiri;eon  of  the  New  York   Hospital 

1796-1817 

The  first  American  physician  to  advocate  teach 

ing  nurses 


Development  of  Nursing  in  America  34^ 

which  are  inseparable  from  virtuous  poverty." 
The  founders  of  this  charity  were  active  in  reHev- 
ing  the  necessities  of  patients  applying  to  it,  but 
no  records  were  kept  before  1837.  In  July  of  that 
year  a  physician  was  put  in  charge  more  es- 
pecially of  the  obstetrical  service,  and  thereafter 
records  w^ere  preserved. 

This  physician  was  Dr.  Joseph  Warrington, 
whose  active  wish  it  had  long  been  to  see  a 
school  for  the  suitable  training  of  women  nurses 
in  connection  w4th  a  hospital  for  lying-in  women. 

He  was  a  man  of  liberal  opinions  and  high 
ideals,  and  it  appears  to  have  been  in  conse- 
quence of  an  urgent  appeal  from  him  that  a 
number  of  ladies  organised  themselves,  on  March 
5,  1839,  into  a  society  whose  constitution  was 
opened  with  this  preamble : 

Whereas,  in  our  widely  extended  and  densely  pop- 
ulated city  a  large  number  of  poor  females  are  subject 
to  great  suffering  and  risk  of  life,  during  and  shortly 
after  the  period  of  parturition,  for  want  of  competent 
nurses  to  guard  them  and  their  helpless  offspring,  and 
to  carry  out  the  directions  of  the  medical  attendant 
.  .  .  the  undersigned,  impressed  with  the  impor- 
tance of  this  subject,  do  associate  for  the  purpose  of 
providing,  sustaining,  and  causing  to  be  instructed 
as  far  as  possible,  pious  and  prudent  women  for  this 
purpose,  and  do  adopt  the  following  regulations : 

I.  The  Association  shall  be  called  the  Nurse  Soci- 
ety of  Philadelphia. 

II.  The  Board  of  Managers  shall  consist  of  twelve 


342  A  History  of  Nursing 

females,    who    are,    or    have     been,  heads    of    fam- 
ilies. ^ 

After  electing  its  officers,  the  board  was  to  take 
up  the  city  districts,  and  place  a  lady  visitor  in 
each.  The  society  was  to  employ,  from  time  to 
time,  as  many  nurses  as  would  be  needed,  and  to 
select,  for  this  purpose,  females  of  settled,  good 
habits,  quiet  and  patient  dispositions,  and  with  a 
sense  of  responsibility.  Only  those  who  were  well 
recommended  were  to  be  employed  and,  if  un- 
suitable, they  were  to  be  dismissed  on  the  advice 
of  the  physician.  There  was  to  be  a  loan  closet 
for  the  use  of  the  patients,  the  articles  to  be  in 
charge  of  a  storekeeper  who  would  distribute 
them  upon  an  order  of  the  visitor  for  the  district, 
when  they  would  be  carried  by  the  nurses  to  the 
patients.  The  nurses  were  to  hold  themselves 
in  readiness  to  be  called  by  the  physician.  Each 
nurse  was  to  spend  her  whole  time  with  one  pa- 
tient, and  was  paid  two  dollars  and  a  half  a  week 
by  the  society.  The  nurses  were  supervised,  when 
on  duty,  by  the  lady  visitor  of  the  district  and  were 
taught  by  the  physicians  in  the  lying-in  depart- 
ment of  the  dispensary.  The  plan  of  instruction, 
which  was  followed  from  the  time  of  foundation, 
w^as  arranged  by  Dr.  Warrington,  and  included 
lectures,  with  practice  on    a   manikin.     At   these 

»  The  complete  Reports  of  the  society  have  been  consulted 
and  data  given  are  taken  almost  entirely  from  them.  It 
is  this  society  that  has  been  already  referred  to  as  resembling, 
and  possibly  being  related  to,  Mrs.  Fry's  work  in  training 
nurses  in  England. 


Development  of  Nursing  in  America  343 

lectures  both  the  nurses  and  young  medical  prac- 
titioners were  taught  together.  ^ 

After  having  served  satisfactorily  for  six  cases, 
they  were  to  receive  appropriate  certificates, 
signed  by  the  physician  in  charge  and  the  lady 
visitor  of  the  district,  and  were  then  eligible  for 
calls  to  private  duty.  They  worked  simply  as 
nurses,  not  as  mid  wives,  and  it  w^as  the  desire 
of  the  society  not  to  limit  its  useftilness  to  ob- 
stetrical cases.  Practically,  however,  these  were 
the  only  calls.  The  ''Nurse  Committee"  kept  a 
list  of  applicants  for  the  position  of  nurse,  made 
the  necessary  inquiries,  and  recommended  candi- 
dates to  the  Board  of  Managers  and  the  physicians. 
Accepted  candidates  were  called  probationers. 
Between  1839  and  1850  the  Nurse  Society  had 
employed  fifty  women,  and  most  of  them  had  an 
honourable  record.  Only  one  was  dropped  for 
misconduct  and  four  for  intoxication. 

In  1849  a  Home,  the  need  of  which  had  long 
been  urgently  felt,  was  secured,  and  opened  as  a 
Home  and  School  in  1850.  The  applicants  were 
now  admitted  as  "pupil -nurses"  and  were  first 
instructed  in  cooking  in  the  home  kitchen 
for  a  few  weeks'  time.  They  next  received 
a  course  of  theoretical  instruction  from  the 
physicians,  and  were  then  sent  out  to  cases  for 
two  weeks  at  a  time.  The  committee  reported 
the  results  of  the  Home  and  the  better  teaching 

»"  Training  Schools  for  Nurses,"  Penn.  Monthly,  Dec, 
1874,  C.  P.  Putnam,  Boston.    Appendix  by  S. 


344  A  History  of  Nursing 

to  be  most  gratifying,  and  the  applicants  of 
a  better  grade.  Still  the  service  remained  al- 
most solidly  obstetrical,  though  the  managers 
greatly  desired  to  extend  it  to  medical  and 
surgical  cases.  Nurses  who  had  received  their 
certificates  were  now  allowed  to  remain  in  the 
Home  for  a  moderate  rental,  and  take  private  duty 
calls.  By  1853  the  loan  closet  had  been  extended 
by  numerous  appliances  for  ordinary  sick-nursing, 
and  a  resolution  was  passed  by  the  society  re- 
minding the  public  that  nurses  would  be  supplied 
for  medical  and  surgical  cases.  It  is  not,  however, 
evident  from  the  reports  that  there  was  any  train- 
ing given  them  on  these  lines,  further  than  some 
lectures  and  demonstrations  in  bandaging.  In 
1855  a  leaflet  appeared  signed  by  Dr.  Warrington, 
Hannah  ]\Iiller,  and  Ann  Davis,  making  an  earnest 
plea  to  young  women  to  enter  the  nurse's  calling. 
It  drew  attention  to  the  fact  that  the  demand  for 
nurses  was  far  greater  than  the  supply,  as,  out  of 
1656  calls,  only  670  could  be  answered.^ 

To  help  to  bring  the  work  before  the  public  and 
impress  its  importance  upon  the  students  them- 
selves, it  was  now  agreed  that  the  "certificates  of 
approbation,"  as  the  nurses'  certificates  were 
called,  should  be  formally  presented  to  them  at 
the  annual  meeting  of  the  society. 

1  Ann  Davis  afterward  studied  medicine,  and  in  1863  wrote 
another  pamphlet,  called  Nursing  the  Sick  and  the  Training 
of  Nurses.  This  was,  however,  chiefly  addressed  to  the 
heads  of  families,  and  is  of  a  slight  character,  though  marked 
with  good  feeling  and  common-sense. 


Development  of  Nursing  in  America  345 

The  report  of  1867  shows  steady  progress.  It 
gives  a  list  of  "graduate  nurses"  residing  in  or 
registering  at  the  Home,  and  records  252  patients 
as  having  received  medical  and  nursing  care. 
There  were  then  thirty-four  lady  visitors  for  the 
districts,  some  districts  having  two  visitors.  The 
69th  annual  report  gives  a  slight  historical  resume 
of  the  work  of  the  society,  and  refers  to  the  share 
of  Dr.  Warrington  in  its  formation  in  the  following 
words:  "One  of  the  primary  objects  of  Dr.  Jo- 
seph Warrington  in  founding  this  society  in  the 
year  1828  was  to  provide,  in  connection  with  the 
hospital  for  women  during  confinement,  a  school 
in  which  women  would  be  practically  trained  in 
the  art  of  nursing."  This  reference  to  Dr.  War- 
rington, and  the  introduction  of  this  new  date, 
1828,  leads  one  to  suppose  that  he  had  had  the 
purpose  in  mind,  and  had  identified  himself  with 
some  earlier  effort  than  that  related  in  the  reports 
quoted,  and  which  had,  probably,  led  logically 
to  the  establishment  of  the  organised  society,  al- 
though the  fact  had  not  been  made  quite  evident 
in  the  earhest  reports.  The  69th  report  says  of 
the  school,  "It  is  the  first  Nurse  Training  School 
in  point  of  time  founded  in  America,  and  we  have 
the  record  of  but  one  in  Europe  of  longer  stand- 
ing." The  70th  annual  report  bears  on  its  title- 
page,  after  the  name,  the  words,  "  In  active  opera- 
tion since  1828:  The  First  School  in  America 
established  to  Train  Women  as  Nurses." 

As  a  pioneer  effort  it  is  certainly  most  interest- 


34^  A  History  of  Nursing 

ing  and  commendable  and  affords  a  valuable  study 
of  co-operation  and  intelligent  thought  in  advance 
of  those  times.  Since  the  full  reform  of  nursing 
has  been  directed  by  ]\liss  Nightingale  this  excel- 
lent old  charity  has  not  continued  to  advance 
along  the  whole  line.  In  1897  it  extended  its 
course  to  one  year,  but  the  nurses  were  sent  out 
to  private  duty  after  three  months'  hospital 
service.  The  hours  retained  the  old-fashioned 
stamp: — rise  at  5.30;  wards  at  6;  breakfast,  7-8; 
daily  duty,  12  J  hours. 

The  next  oldest  school  in  Philadelphia  is  that 
of  the  Woman's  hospital.  This  entire  story  is 
one  of  pioneer  struggle  to  break  new  paths  along 
the  lately  won  and  difficult  road  of  medical  edu- 
cation for  women,  and  the  nursing  shared  in 
the  difficulties  of  the  whole  work.  The  nurs- 
ing school  had  been  planned  and  hoped  for  at 
a  much  earlier  date  than  that  of  the  begin- 
ning of  actual  work,  for  it  was  open  to  pupils  in 
1 86 1,  but  none  offered  themselves  until  1863.^ 
It  did  not  advance  much  before  1872,  when 
it  received  an  endowment  which  enabled  it  to  ex- 
tend its  advantages,  and  little  by  little  it  has 
brought  up  its  standards  to  those  of  the  present 
day. 

Another  interesting  early  nursing  foundation, 
which  has  also,  and  with  better  reason,  been  called 
the  "first  training  school  for  nurses  in  America,'* 
was  that  of  the  New  England  Hospital  for  Wo- 

1  "  Training  Schools  for  Nurses,"  Penn.  Monthly,  cii. 


Development  of  Nursing  in  America  347 

men  and  Children.  It  also  is  closely  bound  up 
with  the  history  of  the  first  medical  women  of  our 
country,  especially  with  that  of  Dr.  Marie  Zakr- 
zewska,  who  was  one  of  the  most  brilliant  and 
original  in  force  and  ability.  Dr.  Zakrzewska  was 
a  German-Pole,  highly  educated,  who  was  familiar 
with  the  training  for  nurses  then  given  in  the  secu- 
lar school  of  the  Charite  hospital  in  Berlin,  where 
she  had  studied  midwifery,  and  later,  medicine. 
As  she  was  not  permitted  to  take  a  medical  degree 
in  Germany,  she  came  to  America,  where  Dr. 
Elizabeth  Blackwell's  heroic  courage  and  eminent 
ability  had  recently  "hammered  at  the  gates  "  ^ 
of  medical  education  for  women.^  In  1859  Dr. 
Zakrzewska  was  appointed  to  the  chair  of  obstet- 
rics in  the  New  England  Female  College  of  Boston, 
and  it  was  due  to  her  advice  that  the  trustees 
established  a  small  hospital  and  clinical  depart- 
ment in  connection  with  it.  The  report  of  1859- 
60  says :  "In  addition  to  the  w^ork  already  spoken 
of  [in  the  hospital  and  clinics]  we  early  expressed 
our  hope  to  receive  and  instruct  women  desiring 
to  be  trained  for  nurses.  This  hope  we  still  cher- 
ish. We  have  had,  as  yet,  but  one  application  in 
this  department." 

In  the  next  two  years.  Dr.  Zakrzewska  trained 
six  nurses  here,  though  they  did  not  receive  cer- 
tificates.    In  the  early  part  of  1862  she  withdrew 

1  Phrase  used  by  Oliver  Wendell  Holmes :  Medical  Essays, 
"  Scholastic  and  Bedside  Teaching,"  p.  299. 

2  For  interesting  details  of  that  struggle  see  Dr.  Blackwell's 
book  cited,  p.  201. 


34^  A  History  of  Nursing 

from  this  position  to  take  one  of  wider  usefulness 
offered  to  her  by  a  group  of  noble  and  courageous 
pioneers  in  education  who  had  organised  the  New 
England  Hospital  for  Women  and  Children  and 
had  asked  her  to  take  charge  of  it.  The  honoured 
names  of  Ednah  D.  Cheney,  Lucy  Goddard,  Louisa 
C.  Bond,  Lucretia  French,  and  many  others  well 
known  in  New  England  are  bound  up  closely  with 
the  history  of  this  institution,  as  well  as  those  of 
a  few  liberal  men  who  believed  in  opening  the 
gates.  The  incorporation  act  declared  the  objects 
of  the  hospital  to  be  : 

L  To  provide  for  women  medical  aid  by  compe- 
tent physicians  of  their  own  sex.  II.  To  assist  edu- 
cated women  in  the  practical  study  of  medicine.  III. 
To  train  nurses  for  the  care  of  the  sick. 

The  training  of  nurses  was  now  begun,  though 
not  precisely  on  the  lines  of  a  training  school.  Yet 
in  the  period  of  about  ten  years  before  the  regular 
school  was  established  Dr.  Zakrzewska  taught 
thirty-two  nurses,  and,  as  she  was  a  strict  discipli- 
narian, with  high  standards  of  practical  work  and 
very  thorough  in  methods,  they  became  "expe- 
rienced nurses  "  of  an  excellent  tyipe.  The  annual 
report  for  1864-65  mentions  "the  faithful  care  of 
our  nurses  "  and  again  says : 

Each  department  of  the  hospital  is  under  the 
charge  of  a  head  and  assistant  nurse.  The  latter  are 
often  women  who,  wishing  to  gain  experience  for  pri- 


Development  of  Nursing  in  America  349 

vate  nursing,  enter  the  hospital  for  a  period  of  six 
months,  during  which  time  they  give,  in  exchange  for 
instruction,  their  services  free  of  remuneration.  .  .  . 
At  this  present  moment,  the  head  nurse  of  the  med- 
ical department  is  a  woman  of  unusual  skill  and 
generosity,  who  serves  the  hospital  from  real  inter- 
est, having  twice  left  very  lucrative  private  nursing 
in  oraer  to  take  charge  of  our  hospital. 

The  report  for  1867-68  says: 

We  have  again  considered  the  subject  of  educating 
nurses,  and  offer  the  advantages  of  the  practice  of  the 
hospital,  with  board  and  washing,  and  also  low  wages, 
after  the  first  month  of  trial,  to  those  women  who  wish 
to  acquire  skill  in  this  important  art.  As  yet  we  have 
had  but  few  applicants  who  are  willing  to  give  the 
requisite  time.  We  do  not  feel  willing  to  be  responsi- 
ble for  the  fitness  of  a  nurse  who  has  been  with  us  for 
less  than  six  months. 

Two  years  later  the  report  says:  ''There  is 
great  demand  for  competent  nurses.  The  few 
who  have  faithfully  served  their  time  with  us  find 
more  than  they  can  do,  and  take  rank  at  once  as 
superior,  first-class  nurses." 

In  1872  the  hospital  moved  to  the  new  building 
at  Roxbury,  and  the  modern  school  of  nursing 
dates  from  this  time.  With  ampler  accommoda- 
tions, and  reinforced  by  the  enthusiasm  of  Dr. 
Susan  Dimock,  who  was  just  back  from  her  studies 
in  Zurich  to  take  the  post  of  resident  physician, 
the  managers  announced  in  their  report  for  1871- 
72: 


350  A  History  of  Nursing 

In  order  more  fully  to  carry  out  our  purpose  of  fit- 
ting women  thoroughly  for  the  profession  of  nursing, 
we  have  made  the  following  arrangements:  Young 
women  of  suitable  acquirements  and  character  will  be 
admitted  to  the  hospital  as  school  nurses  for  one  year. 
This  year  will  be  divided  into  four  periods:  three 
months  will  be  given  respectively  to  the  practical 
study  of  nursing  in  the  medical,  surgical,  and  mater- 
nity wards,  and  night  nursing.  Here  the  pupil  will 
aid  the  head  nurse  in  all  the  care  and  work  of  the  ward 
under  the  direction  of  the  attending  and  resident  phy- 
sicians and  medical  students.  In  order  to  enable 
women  entirely  dependent  upon  their  work  for  support 
to  obtain  a  thorough  training,  the  nurses  will  be  paid 
for  their  work  from  one  to  four  dollars  per  week  after 
the  first  fortnight,  according  to  the  actual  value  of 
their  services  to  the  hospital.  A  course  of  lectures  will 
be  given  to  nurses  at  the  hospital  by  physicians  con- 
nected with  the  institution,  beginning  January  21st. 
Other  nurses  desirous  of  attending  these  lectures  may 
obtain  permits  from  our  physicians.  Certificates  will 
be  given  to  such  nurses  as  have  satisfactorily  passed 
a  year  in  practical  training  in  the  hospital. 

The  same  report  adds : 

As  long  as  we  were  in  the  old  hospital,  with  space 
so  inadequate  to  our  needs,  we  were  able  to  carry  out 
only  partially  our  plans  for  training  nurses,  but  finding 
the  demand  so  constant  for  those  we  have  already 
trained,  and  the  need  of  good  nurses  so  great  in  the 
community,  we  have  now  determined  to  use  our  in- 
creased facilities  to  the  utmost,  and  each  year  to  send 
out  a  small  band  of  trained  nurses.     At  present  we 


Development  of  Nursing  in  America  351 

have  five  in  training  for  the  lengthened  period  of 
twelve  months. 

The  report  of  1872-73  mentions  the  great  success 
of  the  new  method  of  training,  and  of  the  wi^tei  's 
course  of  twelve  lectures — these  being  so  numer- 
ously attended  by  ladies  from  outside  that  it  be- 
came necessary  to  regulate  admission  by  ticket. 
The  resident  physician's  report  tells  the  following 
pleasing  incident: 

Last  summer  the  nurses,  having  heard  that  the 
hospital  was  much  in  need  of  money,  gave  one-fourth 
of  their  wages  for  the  rest  of  the  year,  saying  they 
would  like  to  do  this  much  for  the  hospital  since  it  had 
done  so  much  for  them. 

The  uniform  of  the  early  days  was  perhaps  not 
very  strict  in  uniformity.  *'  A  simple  calico  dress 
and  felt  slippers"  is  the  delightfully  unsophisti- 
cated formula  given  in  the  reports. 

The  first  nurse  to  receive  her  certificate,  and 
who  has  since  been  known  by  the  proud  title  of 
"The  First  Trained  Nurse  in  the  United  States," 
was  Miss  Linda  Richards,  whose  nursing  career, 
still  in  full  activity,  has  been  long  and  honourable. 

Miss  Richards  writes  of  those  days : 

Of  the  five  nurses  in  our  class  I  first  entered  the 
school  on  the  day  it  was  opened,  the  other  four  com- 
ing within  six  weeks.*     Even  though  the  course  was 

1  Of  this  first  class  of  nurses  Miss  Linda  Richards  went  to 
Bellevue  as  night  superintendent  in  October,  1873 ;  remained 
there  a  year,   and  then  was  offered  the  position  of   Sister. 


352  A  History  of  Nursing 

far  too  short,  and  the  advantages  few,  we  five  nurses 
of  the  first  class  were  very  happy,  very  united,  and 
pretty  well  instructed.  We  had  no  superintendent 
of  nurses — in  our  ignorance  we  did  not  know  that  such 
an  officer  was  necessary.  As  I  look  back  I  wonder 
that  we  were  as  well  taught  as  was  really  the  case,  and 
I  sometimes  feel  that  we  nurses,  eager  as  we  were  to 
learn,  instructed  the  physicians  nearly  as  much  as 
they  instructed  us. 

The  course  of  lectures  announced  for  the  winter 
of  1873-74  was  as  follows : 

Dr.  Zakrzewska,  i,  "Position  and  Manners  of 
Nurses  in  Families ' ' ;  Drs.  Emily  and  Augusta  Pope, 
4,  "Physiological  Subjects";  Dr.  Sewall,  i,  "Food 
for  the  Sick" ;  Dr.  Dimock,  2,  "  Surgical  Nursing" ; 
Dr.  Morton,  2,  "Childbed  Nursing";  Dr.  Call,  i, 
"The  Use  of  Disinfectants  to  Prevent  Contagion"; 
Dr.  Zakrzewska,  i,  "General  Nursing." 

Helen's  assistant  by  the  committee,  but  declining  this  went  to 
the  Massachusetts  General  hospital  to  take,  the  position  of 
superintendent  of  nurses  which  was  offered  to  her  at  the  same 
time.  Mrs.  Wolhaupter,  another  of  the  first  five,  took  charge 
of  the  maternity  department  in  the  Xew  England  hospital 
after  graduation,  then  went  to  Belle vue  as  head  nurse,  then 
took  charge  of  the  Brooklyn  Homeopathic  Lying-in  hospital, 
and  followed  Miss  Richards  as  superintendent  of  the  Mass.  lu- 
setts  General  training  school  when  the  latter  left  it  to 
study  in  England,  finally  returning  to  her  former  post  in 
Brooklyn.  A  third  graduate,  Miss  Woods,  went  to  Bellevue 
as  head  nurse,  afterwards  holding  a  similar  position  at  the 
Massachusetts  General  for  two  years,  and  then  became  the 
first  night  superintendent  of  the  newly  opened  Boston  City 
hospital.  The  other  two  devoted  themselves  to  private 
nursing. 


Linda  Richards 
'The  First  Trained  Nurse  in  America" 
Taken  after  her  graduation 


Development  of  Nursing  in  America  353 

Miss  Jamme,  who  has  written  an  account  of 
this  school,  of  which  she  was  for  some  years 
superintendent,  says: 

At  this  early  period  there  seems  to  have  been  great 
interest  and  enthusiasm  shown  by  the  pupils,  and  the 
doctors  in  the  hospital  were  especially  interested  in 
teaching  them.  Dr.  Zakrzewska  taught  at  the  bed- 
side all  the  simple  details  of  nursing,  and  all  the  nurses 
made  rounds  every  morning  and  received  the  orders 
for  their  patients.  There  were  no  head  nurses,  no 
superintendent.  Each  nurse  was  given  charge  of 
about  four  patients  and  was  made  responsible  for  their 
medicines,  diet,  baths,  etc.  The  physicians  were  most 
exacting  and  critical  and  demanded  very  much  in  the 
small  details  for  the  comfort  of  the  patients.  The 
hospital  was  very  poor:  the  empty  treasury  was  re- 
plenished only  week  by  week  by  the  personal  efforts 
of  the  directors ;  doubt  and  ridicule  of  the  women  doc- 
tors had  to  be  met  bravely,  consequently  it  needed 
courage  to  believe  in  the  possibility  of  the  success  of 
the  work.  The  nurses  had  to  be  most  economical  and 
supplement  the  efforts  of  the  doctors  and  directors  in 
every  way,  to  keep  the  hospital  alive.  .  .  .  There 
were  only  three  women  in  the  country  who  were  doing 
surgical  work :  Dr.  Cleveland  in  New  York,  Dr.  Eliza- 
beth Kellar  in  Philadelphia,  and  Dr.  Dimock  in  Bos- 
ton. .  .  .  The  school  continued  to  grow  until  in  1882 
the  course  was  extended  to  sixteen  months,  and  it  was 
at  this  time  that  a  superintendent  of  nurses  was  first 
employed.* 

1  "  The   First  Training  School  in  America,"   by  Anna  C. 
Jamm6,  Johns  Hopkins  Hospital  Nurses  AlumncB  Magazine, 
Nov.   1905,  pp.  197-201. 
VOL.  II. — 23. 


354  A  History  of  Nursing 

The  course  of  training  in  this  school  has  now 
been  extended  to  three  years,  and  most  of  the 
pioneers  have  passed  a\Yay.  Dr.  Dimock,  brilHant 
and  enthusiastic,  perished  at  sea  when  she  was  but 
tw^enty-eight  years  of  age.  Dr.  Zakrzewska,  full 
of  years  and  honour,  remained  up  to  the  end  of 
the  century  attending  and  advisory  physician 
of  the  New  England  Hospital  for  Women  and 
Children.! 

The  little  town  of  St.  Catherine's,  on  the  other 
side  of  the  Canadian  border,  comes  into  the  ranks 
of  the  pioneers  at  this  point  in  building  up  a  hos- 
pital and  providing  training  for  nurses.  This 
communit}',  the  first  in  Canada  to  follow  the  ex- 
ample of  ^liss  Nightingale,  began  w^ork  on  these 
lines  in  1864,  and  owes  the  development  and  suc- 
cessful carrying  out  of  its  projects  largely  to  the 
interest  of  Dr.  Mack.  Beginning  with  a  little 
house,  which  was  rented  for  eight  dollars  a  month, 
one  nurse,  and  a  steward,  the  hospital  grew  stead- 
ily, and  Dr.  Alack  became  successively  president 
of  the  board,  physician  of  the  hospital,  and 
manager  and  consulting  physician.  Definite 
teaching  for  the  nurses  took  shape  in  1873, 
when  through  the  influence  of  Dr.  Mack  Miss 
]\loney  was  sent  to  England  to  bring  out  two 
trained  nurses  and  five  or  six  probationers.  A 
nurses'   home  was  planned,  and  in  1874  a  defi- 

»  Dr.  Zakrzewska  is  the  author  of  an  interesting  book 
based  on  her  experiences,  entitled  .4  Practical  Illustration  of 
the  Right  of  Women  to  Labour.     C.  H.  Dall,  Boston,  i860. 


Development  of  Nursing  in  America  355 

nite  scheme  of  instruction  and  training  was  in  op- 
eration. The  hospital  was  called  St.  Catherine's 
General  and  Marine  hospital.  The  nurses  were 
required  to  bind  themselves  to  serve  for  three 
years;  for  the  first  six  months  as  probationers, 
without  remuneration,  and  afterwards  with  a  sti- 
pend, board  (when  not  employed  outside  of  the 
hospital ;  they  were  evidently  sent  to  private  duty 
or  to  other  institutions),  and  uniforms.  Every 
woman  entering  was  required  to  bring  satisfactory 
evidences  of  purity  of  motive,  good  conduct  and 
character,  and  of  having  received  the  elements  of 
a  plain  English  education.  The  report  of  1875 
says :  "  Every  possible  opportunity  is  seized  to 
impart  instruction  of  a  practical  nature,  while 
teaching  will  be  given  in  chemistry,  sanitary  sci- 
ence, popular  physiology  and  anatomy,  hygiene, 
and  all  such  branches  of  the  healing  art  as  a  nurse 
ought  to  be  familiar  with." 

Protestant  sisterhoods  have  also  played  some 
part  in  the  early  nursing  history  of  the  country. 
The  first  impulse  toward  the  formation  of  sister- 
hoods within  the  Protestant  Episcopal  church 
came  from  the  Rev.  Dr.  Muhlenberg,  who  had 
visited  Kaiserswerth  and  had  become  enthusiastic 
over  its  spirit  and  scope  of  work.  He  wrote  a 
pamphlet,  after  his  return  from  Germany,  called 
the  Instruction  of  Deaconesses  in  the  Evangelical 
Church,  and  it  was  largely  due  to  his  influence 
and  suggestions  that  the  creation  of  the  Sisterhood 
of  the  Holy  Communion,  the  first  independent 


356  A  History  of  Nursing 

community  of  Protestant  Sisters  of  Charity  in  the 
United  States,  was  successfully  brought  about  by 
the  pastor  of  the  church  of  the  Holy  Commun- 
ion in  New  York  City.  The  sisterhood  was 
established  in  1845,  thus  being  comcident  with 
the  first  English  sisterhood;  its  organisation,  how- 
ever, was  not  completed  until  1852.  The  Sisters 
taught,  and  made  the  care  of  the  sick  one  of  their 
objects.  They  spent  four  years  in  nursing  the 
patients  of  the  infirmary  supported  by  the  church 
of  the  Holy  Communion,  and,  in  connection  with 
it,  opened  a  dispensan.^  which  has  been  spoken  of 
as  the  beginning  of  the  path  which  led  to  the 
founding  of  St.  Luke's  hospital;  then,  when  this 
hospital  was  opened  in  1859  under  the  auspices  of 
the  church,  the  Sisters  were  transferred  to  it  and 
remained  in  charge  until  the  establishment  of  the 
secular  nursing  school  in  1888. 

The  sisterhood  still  retains  many  fields  of  activ- 
ity, and  professes  the  care  of  the  sick  as  a  chief 
interest.  The  rules  of  the  house,  with  the  excep- 
tion of  a  few  minor  details,  were  adapted  from 
those  of  Kaiser svrerth,  and  one  of  the  Sisters  of  the 
earlv  period  of  organisation  had  gone  there  for 
some  training.  This  Sister,  as  superintendent  of  St. 
Luke's  hospital  later,  was  active  in  the  movement 
to  prepare  nurses  for  the  war  of  1861-64  by  taking 
them  into  the  civil  hospitals  for  a  short  and  hur- 
ried preparation  for  the  overwhelming  exigencies 
of  military  hospital  service.  Excellent  and  devoted 
work  in  this  direction  was  also  carried  on  by  a 


Development  of  Nursing  in  America  35  7 

Protestant  Sister  in  Baltimore,  Mrs.  Adeline  Ty- 
lor,  who  had  also  had  a  certain  amount  of  training 
at  Kaiserswerth,  and  who,  as  the  head  of  a  com.- 
munity  in  Baltimore,  conducted  two  large  war 
hospitals  in  Chester  and  Annapolis.^ 

When  the  appalling  outburst  of  "man's  inhu- 
manity to  man,"  the  Civil  War,  swept  like  a  storm 
over  the  land,  overshadowing,  for  the  time  being, 
every  smaller  and  less  cosmic  preoccupation,  it 
washed  away  the  petty  anchors  which  had  kept 
the  majority  of  women  carefully  moored  in  the 
quiet  remote  little  bays  of  domestic  seclusion,  and 
they  floated  out  upon  the  stream  of  public  duties. 
Abhorrent  as  is  the  whole  idea  of  war  to  those  who 
see  in  man  nobler  possibilities  than  those  of  beasts 
of  prey,  it  is  nevertheless  impossible  not  to  recog- 
nise the  immense  opportunities  for  rearrangement 
of  social  orders  which  it  has  given ;  and  in  the  case 
of  women  it  is  a  striking  fact  that  their  modern 
movement  toward  legal  and  social  freedom  re- 
ceived an  enormous  impetus  from  the  dynamic 
forces  of  three  epoch-making  wars .  Thus ,  the  war  of 
Freedom  gave  the  women  of  Germany  their  open- 
ing to  make  their  ability  felt ;  out  of  the  Crimean 
War  emerged  the  figure  of  Florence  Nightingale, 
whose  memory  and  influence  will  live  long  after  all 
the  military  achievements  of  that  time  are  forgotten ; 
and  lastly,  the  Civil  War  marks  the  beginning  of 
all  organised  concentration  of  women  in  this  coun- 
try in  public  duties. 

»  A  Century  of  Nursing,  cit. 


35^  A  History  of  Nursing 

To  give  even  a  partial  estimate  of  the  extent 
and  complexity  of  the  affairs  administered  by 
women  during  the  war  is  out  of  the  question,  and 
even  the  vast  proportion  of  the  care  of  the  sick 
and  wounded  can  be  touched  on  only  in  barest 
outline.^  To  tell  the  story  of  that  war-time  nurs- 
ing is  out  of  our  power.  Much  of  it  will  probably 
never  be  told,  nor  will  many  of  its  actors  be  known 
to  posterity.  The  energy  and  ability  of  the  women 
were  expressed  through  the  Sanitary  Commission, 
and  this  body,  which  took  the  place  occupied  to- 
day by  Red  Cross  organisations,  received  its  first 
impulse  from  them,  for  its  historian  says :  "  The 
earliest  movement  that  was  made  for  any  relief 
was  begun,  it  is  hardly  necessary  to  say,  by 
the  women  of  the  country."  2  Two  especially 
notable  figures  are  associated  with  its  forma- 
tion: Dr.  Elizabeth  Blackwell,  probably  the 
most  commanding  personality  among  our  pio- 
neer physicians,  and  ]\liss  Louisa  Lee  Schuyler, 
whose  mind  was  worthy  of  her  great  ancestor 
Alexander  Hamilton.  Dr.  Black\\'ell  returned 
from  England,  where  she  had  been  in  intimate  re- 
lation with  ]\liss  Nightingale,  full  of  enthusiasm,  in 
1 86 1.     She  called  an  informal  meeting  of  women 


1  It  is  estimated  that  two  thousand  women  were  engaged 
in  nursing  and  hospital  administration  during  the  Civil 
War. 

2  History  of  the  United  States  Sanitary  Commission.  By 
Charles  J.  Stills.  J.  B.  Lippincott  and  Co.,  Philadelphia, 
1866. 


Development  of  Nursing  in  America  359 

together  at  the  New  York  Infirmary  for  Women 
and  Children,  which  she  had  founded  some  seven 
years  previously.  They  formed  the  Ladies'  Cen- 
tral Relief  Committee,  and  drafted  a  letter  calling 
for  a  mass-meeting  at  Cooper  Union,  and  there,  on 
April  26,  1861,  the  proposed  Relief  Association 
was  enthusiastically  endorsed  and  enlarged,  Miss 
Louisa  Schuyler  being  elected  president.  There 
had  been  some  even  earlier  steps  taken.  On  the 
15th  of  April,  the  day  on  which  the  President's 
call  for  troops  appeared,  the  women  of  Bridgeport, 
Connecticut,  and  those  of  Charleston,  South  Car- 
olina, had  organised  societies  to  provide  relief, 
nursing,  and  comforts  for  the  volunteers,  and  a 
few  days  afterwards  the  women  of  Lowell,  Massa- 
chusetts, had  done  the  same.  On  the  19th  of 
April  the  women  of  Cleveland,  Ohio,  had  organ- 
ised with  the  purpose  of  assisting  the  families  of 
volunteers. 

The  call  to  the  Cooper  Union  meeting  was  a 
stirring  document,  and  was  signed  by  ninety-two 
women,  one  of  whom  was  Mrs.  Griffin,  later,  and 
for  many  years,  the  president  of  the  Belle vue  train- 
ing school  for  nurses.  The  preliminary  meeting 
at  the  infirmary  had  been  attended  by  men  also, 
one  of  whom,  the  Rev.  Dr.  Bellows,  assisted  in 
framing  the  constitution  which  was  adopted  for 
the  Women's  Central  Association  of  Relief,  and 
which  recited,  among  others,  as  its  objects:  "To 
collect  and  disseminate  information  upon  the 
actual  and  prospective  wants   of  the  army;  to 


360  A  History  of  Nursing 

establish  recognised  relations  with  the  medical 
staff  and  to  act  as  an  auxiliary  to  it ;  to  maintain 
a  central  depot  of  stores  and  to  open  a  bureau  for 
the  examination  and  registration  of  nurses."  The 
first  overture  made  by  the  society  to  the  military 
officials  met  with  a  severe  rebuff,  and  Dr.  Bellows, 
the  delegate,  was  so  convinced  by  the  sweeping 
statements  made  to  him  of  the  full  readiness  of  the 
army  medical  department  for  all  emergencies 
(again,  as  at  Scutari,  nothing  was  wanted)  that  he 
returned  to  the  women  and  reported  that  he  be- 
lieved their  efforts  were  unnecessary,  and  would 
only  appear  to  be  foolish.  The  women,  however, 
disbelieved  this  statement  and  refusing  to  adopt 
this  view  continued  their  preparations.  Events 
soon  convinced  Dr.  Bellows  also  that  he  had  been 
too  optimistic. 

Miss  Schuyler  and  her  colleagues  early  realised 
the  gigantic  extent  of  the  task  before  them,  and, 
largely  through  their  efforts,  the  Woman's  Cen- 
tral Relief  Association  joined  with  the  Board  of 
Physicians  and  Surgeons  of  the  Hospitals  of  New 
York  and  the  ]\Iedical  Association  for  Furnishing 
Hospital  Supplies  in  making  that  joint  appeal  to 
the  President  for  the  creation  of  a  national  official 
commission  which  resulted  in  the  order  issued  by 
the  Secretary  of  War  on  June  9,  1861,  creating 
the  body  which  was  known  as  the  Sanitary  Com- 
mission. Eight  men  of  eminence  and  absolute  in- 
tegrity were  appointed.  Dr.  Bellows  being  chosen 
president.      The    Woman's    Central    Association 


Development  of  Nursing  in  America  361 

of  Relief  now  became  a  branch  of  the  Sanitary 
Commission,  and  co-ordinated  all  of  the  relief 
organisations  throughout  the  country,  stimulat- 
ing the  formation  of  branches  where  they  did  not 
exist,  and  bringing  all  into  one  harmonious  and 
magnificent  system.  ^  Dr.  Blackwell  was  so  ham- 
pered by  masculine  jealousy  in  all  she  tried  to 
do  at  that  time  that,  rather  than  jeopardise  the 
cause  to  which  her  heart  was  given,  she  retired 
from  a  prominent  share  in  the  administrative  work 
of  the  commission,  while  none  the  less  actively  en- 
gaging in  its  service.  The  preparation  of  women 
as  nurses  for  the  wounded  soldiers  absorbed  her 
attention  for  a  time,  and,  in  co-operation  with  a 
committee  of  women,  she  selected,  trained  (as  well 
as  the  pressure  of  the  emergency  would  allow), 
and  sent  to  the  front  about  one  hundred  nurses. 
In  her  own  book  she  says  that  the  most  prom- 
ising of  them  were  sent  to  Belle vue  Hospital  for  a 
month.2  Dr.  Blackwell  had  long  been  deeply  in- 
terested in  the  question  of  training  for  nurses, 
and  her  intimacy  with  Miss  Nightingale  must 
have  accentuated  this  interest.  Her  influence  and 
knowledge  were  continually  exerted  in  behalf  of 
good  teaching  and  a  higher  standard,  but  she  has 
been  so  modest  and  unassuming  about  her  own 
work  that  the  full  influence  of  her  ideas  in  the  final 

1  See  letter  from  Miss  Louisa  Schuyler  to  the  235  Women's 
Branches,  United  States  Sanitary  Commission  by  Katherine 
P.  Wormeley,  Boston,  1863,  appendix,  pp.  271-274. 

2  Op.  cit.,  p.  236. 


362  A  History  of  Nursing 

evolution  of  trained  nursing  will  perhaps  never  be 
quite  realised.  In  1859  she  and  her  sister  Em- 
ily had  prepared  a  statement  of  their  aims  and 
intentions  for  the  New  York  Infirmary  for  Women 
and  Children  which  had  been  incorporated  in  1854 
for  three  purposes:  the  relief  of  the  sick  poor; 
the  training  of  women  physicians;  the  training  of 
nurses.  In  their  statement  the  sisters  said:  "In 
this  hospital  we  would  also  establish  a  system  of 
instruction  for  nurses, — its  plans  to  be  based  on 
those  drawn  up  by  ^liss  Nightingale  for  her  pro- 
posed school  in  London,  .  .  .  with  which,  though 
never  yet  published,  we  are  well  acquainted."' 
Long  after  training  schools  were  an  accomplished 
fact  a  friend  said  to  Dr.  Blacla\^ell:  ''Thee  has 
had  so  much  to  do  with  the  reform  of  nursing,  I 
think  it  is  too  bad  thy  share  in  it  has  not  had 
more  recognition."  ''\Miat  does  it  matter," 
she  answered,  "so  long  as  the  work  itself  is 
done?" 

The  work  of  the  Sanitary  Commission  is  justly 
celebrated  as  a  magnificent  record  of  humanitarian 
work.  Its  leaders  were  all  thoroughly  acquainted 
with  the  sanitar}'  history  of  the  Crimean  campaign 
and  with  ^liss  Nightingale's  work  (it  is  known, 
moreover,  that  they  had  her  counsel  and  advice), 
and  their  purpose  from  the  outset  was  to  prevent 
useless  suffering  and  to  minimise  sickness  by  hy- 

»  Medicine  as  a  Profession  for  Wotnen.  Read  at  Clinton 
Hall,  Dec.  2,  1859.  Published  by  Tinson,  Xew  York,  at  the 
request  of  the  trustees  of  the  infirmary,  in  i860. 


Development  of  Nursing  in  America  3^3 

gienic  precautions.  Owing  to  military  opposition 
and  jealousy  ^  they  were  not  always  able  to  carry 
out  their  plans  for  prevention,  though  these  were 
always  made  with  far-sighted  wisdom.  For  the 
care  of  the  sick  and  wounded  soldiers,  an  admi- 
rable system  of  hospitals  was  eventually  developed 
under  its  fostering  control,  and  though  the  nursing 
had  a  thoroughly  amateur  character  throughout 
the  war,  it  was  carried  on  with  unselfish  devotion, 
and  many  of  the  nurses,  self-taught  and  disciplined 
by  dire  necessity,  attained  a  high  degree  of  practi- 
cal skill.  The  most  definite  landmark  in  the  some- 
what formless  nursing  department  of  the  Civil  War:^ 
was  the  official  appointment  of  Dorothea  Dix  as 
Superintendent  of  Nurses.  This  remarkable  wo- 
man, the  female  Howard  of  this  country,  is  too 
seldom  remembered  by  the  present  generation. 

Dorothea  Lynde  Dix  was  born  in  Maine  in  1802. 
In  1836,  while  travelling  for  her  health,  she  visited 
the  family  of  Mr.  Rathbone  in  Liverpool,  the 
father   of  workhouse   infirmary  nursing   reform, 

1  Their  plans  were  looked  upon  as  a  deep-laid  scheme  for 
some  selfish  purposes,  and  the  Secretary  of  War  at  first  asked 
the  delegates  to  state  frankly  precisely  what  they  wanted, 
since  it  was  evident  they  could  not  want  only  what  they 
seemed  to  be  asking  for.  The  history  mentioned  says:  "It 
is  humiHating  to  record  the  utter  inability  on  the  part  of  our 
highest  American  officials  to  appreciate  the  best-considered 
and  most  widely  extended  system  of  mitigating  the  horrors 
of  war  known  in  history,  and  especially  at  a  time  when  the 
existence  of  the  government  was  dependent  upon  the  health 
and  efficiency  of  that  army,  which  the  appointment  of  a  sani- 
tary commission  was  designed  to  promote."  Slill^,  op.  cit., 
p.  60. 


364  A  History  of  Nursing 

and  in  1841  she  began  teaching  in  the  prisons  of 
her  native  State.  Her  attention  was  drawn  to  the 
condition  of  the  insane,  which  was  then  quite  as 
horrible,  in  almost  all  parts  of  the  country,  as  in 
the  days  of  Howard.  She  determined  to  investigate 
it  and  for  two  years  made  a  most  searching  per- 
sonal examination  of  every  almshouse  and  jail 
(where  the  insane  were  then  confined)  in  ^las- 
sachusetts.  Like  Howard,  she  kept  an  exact 
record  of  every  fact,  and  when,  at  the  end  of  her 
investigations,  she  memorialised  the  Legislature 
of  ]\Iassachusetts,  her  testimony  of  what  she  had 
seen  was  appalling  and  irrefutable.  Her  earliest 
supporters  were  Dr.  S.  G.  Howe  and  Charles  Sum- 
ner, and  the  result  of  her  work  in  ^vlassachusetts 
was  the  immediate  extension  of  State  care  for  the 
insane.  For  the  next  twenty  years,  in  every  state 
of  the  Union  (and  that  was  in  the  days  of  rough 
travel) ,  she  carried  on  the  same  close  unfaltering 
inspection  and  record-making,  and  took  her  accu- 
sations and  appeals  into  every  Legislature.  As 
no  State  hospitals  then  existed,  she  became  con- 
vinced of  the  necessity  of  applying  the  principle 
of  taxation  to  this  purpose,  and  the  creation  of 
State  hospitals  in  many  states  was  the  direct  result 
of  her  conceptions  and  resolution.  New  Jersey 
was  the  field  of  her  first  victory  in  this  great  piece 
of    constructive    statesmanship,    in    1845. 

After  her  wonderful  campaign  in  the  states  she 
conceived  the  project  of  persuading  Congress  to  set 
aside  twelve  million  acres  of  the  public  domain 


Development  of  Nursing  in  America  365 

for  the  endowment  of  institutions  for  the  insane, 
the  bHnd,  and  other  helpless  members  of  society, 
and  she  actually  pushed  this  gigantic  undertaking 
successfully  through  both  houses  of  Congress,  and 
saw  her  ideal  about  to  be  realised,  only  to  be  fairly 
crushed  by  a  disappointment  totally  unexpected, 
for  the  President,  Franklin  Pierce,  small  of  calibre 
and  mediocre  of  mind,  had  the  power  to  undo  and 
prevent  great  things  which  he  was  not  capable  of 
creating,  and  he  vetoed  the  bill. 

Miss  Dix  afterward  travelled  abroad  and  carried 
on  investigations  into  the  condition  of  the  insane 
in  a  number  of  foreign  countries.  Her  appoint- 
ment to  the  superintendency  of  the  war  nursing 
was  in  recognition  of  her  vast  public  services,  but 
she  was  then  nearly  sixty  years  old,  worn  from  her 
exhausting  life-work,  and  could  not  adapt  herself 
to  the  general  conditions  of  a  hospital  service. 
She  herself  said  that  this  was  not  the  part  of 
her  life  by  which  she  wished  to  be  judged.  Her 
standards  were  high  and  inflexible,  and  she  antag- 
onised many  of  those  with  whom  she  was  obliged 
to  work.     She  died  in  1887.1 

»  See  Life  of  Dorothea  Lynde  DiXy  by  Francis  Tiffany. 
Houghton,  Mifflin  &  Co.,  Boston,  1896. 

Circular  No.  7,  issued  from  the  Surgeon-General's  office  in 
the  War  Department,  read:  "In  order  to  give  greater  util- 
ity to  the  acts  of  Miss  Dorothy  L.  Dix  as  superintendent  of 
women  nurses  in  general  hospitals,  and  to  make  the  employ- 
ment of  such  nurses  conform  more  closely  to  existing  laws, 
•  .  .  Miss  Dix  has  been  entrusted  by  the  War  Depart- 
ment with  the  duty  of  selecting  women  nurses  and  assigning 
them  to  general  or  permanent  military  hospitals.     Women 


366  A  History  of  Nursing 

The  medical  profession  first  went  on  record  in 
regard  to  nursing  reform  in  May,  1869,  when,  at 
the  New  Orleans  meeting  of  the  American  Medical 
Association,  a  report  of  a  Committee  on  the  Train- 
ing of  Nurses,  whose  chairman  was  Dr.  Samuel 
Gross,  was  presented  to  the  meeting.  The  com- 
mittee was  a  special  one,  appointed  to  inquire  into 
the  best  method  of  organising  and  conducting 
institutions  for  the  training  of  nurses,  and  some 
of  its  conclusions  are  of  much  interest.  The  report 
recited  the  strange  neglect  of  nursing  in  the  United 
States;  the  long-felt  need  of  good  nursing;  men- 
tioned the  fact  that  the  Catholic  orders  were  the 
only  ones  who  seemed  to  realise  its  importance; 
and  said :  "  It  is  perhaps  fortunate  that  the  mor- 
tality occasioned  by  bad  nursing  cannot  be  esti- 

nurses  are  not  to  be  employed  in  such  hospitals  without 
her  sanction  and  approval  except  in  case  of  urgent 
need. 

Women  nurses  will  be  under  the  control  and  direction  of 
the  medical  officer  in  charge  of  the  hospital  to  which  they  are 
assigned,  and  may  be  discharged  by  him  if  incompetent,  in- 
subordinate, or  otherwise  unfit  for  their  vocation.  Miss  Dix  is 
charged  with  diligent  oversight  of  women  nurses,  and  with 
the  duty  of  ascertaining  by  personal  inspection  whether  or  not 
they  are  properly  performing  their  duties,  and  medical  officers 
are  enjoined  to  receive  her  suggestions  and  counsel  with 
respect  and  to  carry  these  into  effect  if  compatible  with  the 
hospital  service. 

As  it  will  be  impossible  for  Miss  Dix  to  supervise  in  person 
all  the  military  hospitals  she  is  authorised  to  delegate  her 
authority.   .   .   . 

Women  wishing  employment  as  nurses  must  apply  to  Miss 
Dix  or  to  her  authorised  agents.  Army  regulations  allow  one 
nurse  to  every  ten  patients  (beds).     As  it  is  the  expressed 


Development  of  Nursing  in  America  3^7 

mated  by  those  most  immediately  affected  by  it, 
as  a  knowledge  of  it  would  entail  upon  them  an 
immense  amount  of  misery  and  mental  anguish. 
Nursing  in  its  more  exact  sense  is  as  much  of  an 
art  and  a  science  as  medicine." 

Then  followed  some  statistical  desciiption  of  all 
the  existing  Protestant  institutions  in  the  Old 
World,  beginning  with  Kaisers werth,  and  including 
all  the  London  hospitals  reformed  up  to  that 
time.  The  report  mentioned  the  early  American 
efforts  and  the  vast  extent  of  volunteer  nurs- 
ing of  the  Civil  War,  and  made  the  following 
recommendations : 

I.  That  every  large  and  well-organised  hospital 
should  have  a  school  for  the  training  of  nurses,  not 
only  for  the  supply  of  its  own  necessities,  but  for  pri- 

will  of  the  government  that  a  portion  of  these  nurses  shall  be 
women,  and  as  Congress  has  given  to  the  Surgeon-General 
authority  to  decide  in  what  number  women  shall  be  substi- 
tuted for  men,  it  is  ordered  that  there  shall  be  one  woman 
nurse  to  two  men  nurses.  Medical  officers  are  hereby  re- 
quired to  organise  their  respective  hospitals  accordingly. 
Medical  officers  requiring  nurses  will  apply  to  Miss  Dix  or  her 
authorised  agents. 

Sisters  of  Charity  will  continue  to  be  employed  as  at  present 
under  special  instructions  from  this  office.  Signed,  Wm.  A. 
Hammond,  Surg. -Gen.  Miss  Dix's  requirements  for  candi- 
dates were  specified  in  the  next  order.  Circular  No.  8,  July  14, 
1862. 

No  candidate  for  position  as  nurse  was  to  be  considered 
unless  she  was  between  the  ages  of  35  and  50.  Matronly  per- 
sons of  experience  and  those  of  superior  education  and  serious 
disposition  were  to  have  the  preference.  Habits  of  neatness 
and  order,  sobriety  and  industry  were  essential. 


368  A  History  of  Nursing 

vate  families;  the  teaching  to  be  furnished  by  its  own 
medical  staff,  assisted  by  the  resident  physicians. 

II.  That,  while  it  is  not  at  all  essential  to  combine 
religious  exercises  with  nursing,  it  is  believed  that 
such  a  union  would  be  eminently  conducive  to  the 
welfare  of  the  sick  in  all  public  institutions,  and  the 
committee  therefore  earnestly  recommend  the  estab- 
lishment of  nurses'  homes,  to  be  placed  tmder  the  im- 
mediate supervision  and  direction  of  Deaconesses  or 
lady  superintendents. 

III.  That,  in  Oi'der  to  give  thorough  scope  and 
efficiency  to  this  scheme,  district  schools  should  be 
formed  and  placed  under  the  guardianship  of  the 
county  medical  societies  of  every  State  and  Territory 
in  the  Union,  the  members  of  which  should  make  it 
their  business  to  impart  instruction  in  the  art  and 
science  of  nursing,  including  the  elements  of  hygiene 
and  ever}'  other  species  of  information  necessary  to 
qualify  the  student  for  the  important  duties  of  the 
nurse. 

The  committee  further  suggested  the  impor- 
tance of  forming,  in  every  convenient  place,  socie- 
ties of  nurses  who  should  have  the  preference  in 
calls  over  the  uneducated  attendants.  This  recom- 
mendation is  an  exceedingly  interesting  one,  and 
well  worthy  of  note  as  original,  since  it  foreshad- 
owed the  actual  developments  of  later  years. 
The  report  concluded  with  a  summary  of  the  qual- 
ities necessary  for  the  nurse  to  possess,  taken, 
apparently,  though  without  acknowledgment, 
from  the  regulations  of  the  Nightingale  school, 
and  it  was  resolved  that  a  copy  of  the  report  should 


Development  of  Nursing  in  America  369 

be    sent    to     medical    societies     all    over    the 

country.  ^ 

1  Proceedings  of  the  American  Medical  Association,  New- 
Orleans,  May.  1869.  Reprint,  Med.  News,  Philadelphia, 
1869,  vol.  XX.,  pp.  339,  351-  In  November  of  this  same  year 
the  celebrated  scientist  Virchow  gave  similar  recommenda- 
tions to  an  association  of  women  in  Berlin,  Germany. 
VOL.  II. — 24. 


CHAPTER  IX 

A  TRIO  OF  TRAINING  SCHOOLS 

THE  war  came  to  an  end,  but  the  splendid  work 
of  the  women  on  the  Sanitary  Commission 
and  of  the  nurses  in  the  field  could  not  die  away; 
their  aroused  energies  could  not  be  stifled,  nor  their 
fields  of  activity  be  again  restricted.  When  they 
returned  from  military  service  it  was  to  take  up 
with  moral  courage  and  determination  a  new  cam.- 
paign  for  the  reformation  of  civil  institutions. 
The  establishment  of  trained  nursing  in  Amicrica 
came  as  the  result  of  the  war  almost  as  directly  as 
it  had  done  in  England.  There,  Miss  Nightingale 
turned  from  one  work  straight  to  the  other ;  here, 
the  women  who  were  to  be  the  future  managers  of 
training  schools  had  their  preliminary  training  in 
the  relief  service.  The  first  three  schools  for  nurses 
established  after  the  war,  those  from  which  the 
steady  march  of  nursing  progress  in  America  dates, 
are  monuments  to  the  creative  energy  of  organised 
women  who  had  learned  their  power.  Two,  at  least, 
of  them  were  the  work  of  women's  committees, 
originating  with  them  and  not  with  hospital  gov- 
ernors or  medical  boards,  and  pushed  through  in 

370 


A  Trio  of  Training  Schools       Z7^ 

spite  of  opposition,  doubts,  and  disapproval  from 
many  quarters.  One  and  the  same  year  saw  this 
trio  of  schools  established  within  the  wards  of 
important  general  hospitals :  Bellevue,  opened  on 
May  I,  the  New  Haven,  on  October  i,  and  the 
Massachusetts  General  on  November  i,  1873. 

In  New  York  State,  with  its  large  population  of 
dependents  of  all  kinds,  herded  together  in  bar- 
rack-like institutions  under  the  general  supervision 
of  the  State  Commissioners  of  Charity,  there 
was  not  a  woman  of  enlightened  intelligence  or 
refinement  in  any  position  of  authority  or  even  of 
inspection.  Miss  Louisa  Schuyler,  who  had  na- 
tionalised the  work  of  the  Sanitary  Commission, 
and  whose  insight  grasped  the  whole  problem, 
organised  the  State  Charities  Aid  Association  of 
New  York  State,  to  act  as  a  volunteer,  unpaid 
body  of  citizens  for  the  improvement  of  the  public 
institutions  of  charity.  Its  form  of  association 
was  completed  on  the  nth  of  May,  1872,  and  Miss 
Schuyler  was  elected  the  first  president.  It  di- 
vided itself  into  three  departments  for  investiga- 
tion and  active  work,  dealing  with:  I — Children. 
II— Adult  and  Abie-Bodied  Paupers.  Ill— The 
Sick  in  Hospitals.  The  association  comprised 
both  men  and  women,  upon  a  broad  humanitarian 
platform,  and  Miss  Schuyler's  early  reports  and 
papers  are  excellent  examples  of  a  union  of  noble 
purpose  with  intellectual  and  practical  ability. 
In  her  first  annual  report,  presented  to  the  Com- 
missioners of  Charity,  she  said,  among  other  things. 


372  A  History  of  Nursing 

in  speaking  of  the  visitors  to  the  institutions,  that 
they 

represent  the  best  class  of  our  citizens  as  regards  en- 
lightened views,  wise  benevolence,  experience,  wealth, 
influence,  and  social  position.  .  .  .  Ours  is  neither 
exclusively  man's  work  nor  woman's  work.  We  are 
men  and  women  working  together,  supplementing 
each  other's  powers.  .   .   . 

You  will  see  that  we  have  aimed  to  place  our  work 
upon  a  foundation  as  broad  as  that  upon  which  our 
own  republican  form  of  government  rests :  to  do  away 
with  all  distinctions  of  race  or  sex,  of  political  parti- 
sanship and  sectarian  prejudice;  to  have  the  work 
judged  by  its  merits  alone,  whether  it  is  or  is  not 
worthy  of  support  from  our  citizens.^ 

The  Hospitals  Committee  began  work  at  once, 
and  defined  its  duties  as  follows : 

I.  To  inform  itself  of  the  number  and  present  con- 
dition of  sick,  inebriate,  insane,  blind,  deaf-and-dumb, 
idiot,  and  aged  paupers  in  the  New  York  State  institu- 
tions of  public  charities,  and  to  urge  the  adoption  of 
such  measures  as  are  best  adapted  to  restore  the 
health,  alleviate  the  sufferings,  secure  the  humane 
care  and  comfort,  and  contribute  to  the  happiness  of 
these  afflicted  and  aged  people. 

II.  To  collect  and  impart  information  in  regard 
to  the  latest  and  most  approved  plans  for  the  con- 
struction, ventilation  and  disinfection  of  hospitals  and 
asylums;  to  prepare  plans  of  organisation  for  their 
kitchens,  linen,  laundry,  and  nursing  departments; 
and    to    acquaint    themselves    with    such    hygienic 

1  First  Annual  Report  S.  C.  A.  A.,  1873. 


A  Trio  of  Training  Schools       373 

and  sanitary  regulations  as  are  in  accordance 
with  the  most  advanced  views  of  the  medical 
profession. 

The  first  section  of  the  Hospitals  Committee 
appointed  to  a  definite  institution  was  formed  on 
Jan.  9,  1872,  to  visit  the  Westchester  poorhouse. 
It  consisted  of  forty-nine  members.  Its  experi- 
ence was  so  strikingly  like  that  of  the  early  Eng- 
lish groups  under  Miss  Twining  and  Miss  Cobbe 
that  it  is  well  to  record  it.  So  long  as  the  ladies 
were  contented  to  work  themselves,  and  to  make 
no  criticism  on  the  management,  everything  went 
smoothly.  With  the  full  knowledge  of  the  super- 
intendents of  the  poor  they  came  and  went,  con- 
ducted sewing  schools,  carried  delicacies  for  the 
sick,  and  cared  generally  for  their  comfort.  But 
the  ladies  became  aware  of  many  things  demand- 
ing immediate  reform:  there  was  an  absence  of 
classification  which  led  to  gross  immorality,  a 
want  of  enlightened  treatment  for  the  insane,  no 
nursing  for  the  sick,  the  children  were  badly  fed, 
badly  clothed,  badly  taken  care  of,  and  exposed  to 
the  degrading  influence  of  the  adult  paupers  in 
charge  of  them.  The  ladies  offered,  through  the 
Children's  Aid  Society,  to  place  the  little  ones 
in  good  homes;  the  superintendents  of  the  poor 
refused,  wanting  them  to  remain  in  the  county 
where  they  could  look  after  them.  The  condition 
of  the  sick  was  especially  pitiable.  "It  is  no  ex- 
aggeration to  say  that  in  most  of  our  county  poor- 
houses  no  nursing  of  the  sick  is  ever  attempted.  .  . 


374  A  History  of  Nursing 

Usually  the  very  ill  patients  are  cared  for  by  those 
in  the  same  room  who  are  less  ill.  .  .  .  Many  pa- 
tients were  in  the  last  stages  of  pulmonary  tuber- 
culosis; in  one  ward  there  were  several  cases  of 
paralysis,  epilepsy,  one  gunshot  wound,  accident 
cases,  amputation,  etc."  In  one  w^ard  the  ladies 
found  a  terrible  case  of  suffering  from  carcinoma 
of  the  face,  and  one  poor  man  crushed  by  a  steam 
shovel  and  in  great  agony.  They  asked  the  su- 
perintendents to  employ  some  one  to  nurse  these 
sufferers ;  their  request  w^as  refused  on  the  ground 
that  there  was  no  appropriation  of  funds  for  such 
expenses.  They  then  begged  to  be  allowed  to  pay 
the  wages  of  a  competent  nurse,  to  be  selected  and 
controlled  by  the  superintendent.  This  was  also 
refused.  "They  could  not,"  said  the  women  in 
their  report,  ''refuse  the  kindness  which  death  at 
last  brought  the  sufferers."  When  the  visitors' 
suggestions  for  improvements  were  first  made, 
they  were  received  with  civility,  but  no  action  w^as 
taken.  Later  they  were  requested  to  come  only 
on  one  day  in  the  week.  Finally,  when  the  visi- 
tors repeated  their  petition  for  better  care  of  the 
children,  and  for  a  nurse  for  the  sick,  offering  to 
pay  the  wages  of  such  attendants  until  the  Board 
of  Supervisors  met,  the  superintendents  told  them 
that  they  had  no  authority  to  interfere,  that  it 
was  desired  that  they  should  no  longer  come  as 
members  of  an  association;  they  might  come  as 
ordinary  visitors,  but  the  superintendents  person- 
ally desired  to  have  no  further  intercourse  with 


A  Trio  of  Training  Schools        375 

them.  Not  long  after  this  they  were  refused 
admittance.  1 

A  perfect  example,  this,  of  the  reasons  why  male 
officials  do  not  want  women  interfering  in  their 
business.  But  in  time,  with  persistent  effort,  re- 
forms were  set  in  motion. 2 

The  second  section,  formed  on  Jan.  26,  1872, 

»  First  Annual  Report  S.  C.  A.  A.,  1873. 

2  The  State  Charities  Aid  Association  stood  upon  the  prin- 
ciple that  the  taxpayers,  supporting  as  they  did  all  of  the  pub- 
lic institutions  and  all  of  the  officials  appointed  to  administer 
them,  had  an  unquestionable  right  to  inspect  these  institu- 
tions and  to  see  how  they  were  managed.  After  their  visitors 
were  turned  out  of  the  Westchester  poorhouse,  the  S.  C.  A.  A., 
including,  as  it  did,  numbers  of  public-spirited  men,  secured 
legislative  enactment  largely  increasing  the  powers  of  the 
State  Board  of  Charities  in  the  matter  of  visiting,  and  then  by 
personal  agreement  with  the  board  it  was  arranged  that  the 
latter  should  appoint  as  its  official  visitors  members  of  the 
voluntary  society  upon  the  recommendation  of  the  latter. 
This  arrangement  lasted  for  eight  years,  during  which  time 
the  foundations  of  reforms  of  the  most  far-reaching  character 
were  laid.  The  perennial  struggle  against  political  corrup- 
tion and  mismanagement  of  public  charitable  funds  then  be- 
came too  heavy  a  strain  on  the  moral  courage  of  the  board. 
It  first  tried  to  suppress  the  reports  made  by  the  visitors  to 
the  S.  C.  A.  A.,  and  so  to  the  public,  and  finding  that  this 
stratagem  was  resisted  it  broke  off  the  relationship  with  the 
volunteer  body.  The  S.  C.  A.  A.,  strong  in  the  support  of 
enlightened  public  opinion,  then  asked  for  legislative  author- 
ity to  continue  its  inspection  of  institutions  and  was  actively 
opposed  by  the  board,  but  finally  secured  the  recognition  it 
asked.  See  Address  from  the  S.  C.  A.  A.  to  its  Local  Visiting 
Committees  throughout  the  State  of  New  York,  July,  1880 
(No.  24  of  publications).  Also  Nos.  25  and  26,  containing 
Mr.  Choate's  argument  before  the  Legislature  and  the  final 
report  of  the  special  committee  in  charge  of  the  bill,  June  io» 
1881. 


37^  A  History  of  Nursing 

was  the  Belle\'iie  Hospital  Visiting  Committee, 
consisting  of  fifty-three  members.  The  ladies 
composing  it  were  called  together  at  the  invitation 
of  Miss  Louisa  Schuyler.  '"  Several  of  them  had 
been  members  of  the  Sanitary  Commission,  and 
had  had  experience  of  hospital  work,  but  the  ma- 
jority had  no  knowledge  of  the  difficulties  of  the 
task  before  them,  and  accepted  it  with  all  the 
bravery  of  ignorance."^  Of  these  ladies,  selected, 
as  they  were,  with  care  as  possessing  every  possi- 
ble equipment  of  ability,  character,  and  social 
position,  many  since  that  time  have  had  a  con- 
spicuously important  and  useful  career  in  the 
civic  and  charitable  reforms  of  the  city  and  have 
been  identified  with  the  whole  movement  of  hos- 
pital and  nursing  advance.  They  now  began 
their  work,  every  member  taking  certain  days  on 
which  to  visit  certain  wards.  The  chairman,  Mrs. 
Joseph  Hobson,  was  a  young  married  woman,  un- 
familiar with  poverty,  sickness,  or  degradation, 
and  who  had  never  been  in  a  hospital.  On  her 
first  visit  to  Bellevue  she  wandered  bewildered 
through  the  long  corridors  and  the  series  of  dou- 
ble wards  opening  out  of  one  another,  wondering 
how  to  begin.  A  sort  of  external  cleanliness  and 
order  prevailed,  yet  she  felt  instinctively  that 
things  were  not  right  somewhere.  As  she  ex- 
plored the  rather  deserted-looking  extent  of  one 

» History  of  the  Establishment  of  the  Bellevue  Training 
School  for  Nurses,  read  at  the  Waldorf-Astoria,  March  6, 
1899. 


A  Trio  of  Training  Schools        zn 

floor,  she  came  upon  a  young  man,  who  appeared 
to  be  a  physician,  and  who  was  busied  about  some 
of  the  patients.  With  some  embarrassment  she 
went  up  to  him  and  introduced  herself  as  an  offi- 
cial visitor,  and  said  she  would  be  grateful  for  a  few 
hints  as  to  what  to  look  into.  "  You  want  to  see 
things  ? ' '  said  the  young  man  with  an  inexplicable 
expression;  "well,  I  can  show  them  to  you.  Do 
not  appear  to  be  with  me,  but  follow  around  after 
me."  The  young  surgeon  was  no  other  than  Dr. 
Gill  Wylie,  who  later  became  so  stanch  a  friend 
of  the  training  school  and  loyal  supporter  of  the 
cause  of  the  training  school  committee.  This  now 
famous  specialist  was  then  a  young  man,  fresh 
from  his  Southern  country  home,  and  held  the  po- 
sition of  interne,  or  house-surgeon,  with  quarters 
in  the  hospital.  Mrs.  Hobson  followed  him,  and 
watched  as  he  lifted  the  bed-clothes  from  a  newly- 
arrived  case  and  proceeded  himself  to  give  the  pa- 
tient— a  woman — some  attempt  at  a  bed-bath. 

It  must  have  been  such  a  case  as  only  old  Belle- 
vue  could  show,  for  the  visitor  was  horror-stricken 
at  the  conditions  she  saw.  Dr.  Wylie  then  con- 
ducted her  to  the  old  bath-rooms  (long  since  demol- 
ished) ,  and  pointed  out  the  litter  of  dirty  rags  on 
the  floor  where  the  "nurse"  (a  ten-day  prisoner 
from  the  Island)  had  her  bed.  The  dinners  came 
up  to  the  wards,  and  the  pieces  of  fish  and  potatoes 
were  dumped  without  dishes  on  the  bare  boards 
of  the  long  tables.  Finally  they  descended  to  the 
laundry,  for  the  housewifely  eye  of  the  lady  had 


37^  A  History  of  Nursing 

not  failed  to  rest  upon  the  dull  grey  sheets  and 
pillow-cases.  In  the  laundry  was  one  lone,  old, 
decrepit  man.  He  constituted,  in  fact,  the  entire 
force  on  duty  in  the  laundry  at  that  time,  and  for 
six  weeks  he  had  had  no  soap,  because  the  appro- 
priation had  run  out.  Incredible  as  this  may 
sound,  it  was  the  plain  and  literal  truth.  For  six 
weeks  there  had  been  no  soap  in  the  laundry  of  a 
hospital  containing  some  hundreds  of  patients, 
and  the  laundry  staff  had  dwindled  to  the  one  lone 
man.i 

On  that  day  all  the  horrors  of  old  Bellevue  were 
doomed  to  extinction. 

A  few  days  after  this  the  committee  met  to  com- 
pare notes,  and,  as  one  after  another  of  the  ladies 
arose  to  read  her  report  and  spoke  of  visits  made 
to  the  patients,  individual  cases  in  distress  helped, 
soups  and  delicacies  carried  to  them,  and  religious 
consolation  brought  to  those  desiring  it,  the  young 
chairman,  unaccustomed  to  all  public  duties,  grew 
hot  and  quaked  with  dread  and  -mortification. 
She  had  not  talked  kindly  with  a  single  patient; 
she  had  taken  them  no  beef  tea;  she  had  not 
inquired  whether  they  would  see  a  clergyman! 
Would  not  her  report  sound  most  heartless  and 
aggressive?  What  would  the  others  think  of  it? 
In  deep  embarrassment  she  read  her  itemised 
account  of  all  she  had  seen  at  Bellevue:  the  filth 
of  the  patients ;  the  degradation  of  the  attendants ; 
the  inadequacy  of  all  housekeeping  details;  the 

1  From  private  sources. 


A  Trio  of  Training  Schools        379 

state  of  the  laundry,  of  the  clothes-rooms,  of  the 
kitchen.  She  told  of  the  tea,  soup,  and  coffee 
made  in  the  same  kettles,  of  the  food  eaten  from 
the  bare  boards  without  plates  and  even  without 
knives,  because  it  was  the  opinion  of  some  one  in 
the  domestic  economy  of  the  place  that  if  the  pa- 
tients had  knives  they  would  cut  themselves. 

There  was  electricity  in  the  air  when  she  fin- 
ished, and  for  a  moment  there  was  silence.  Then 
a  lady  rose  and  moved  that  the  President  should 
present  the  report  to  the  Commissioners  of  Charity 
and  demand  an  investigation. 

That  winter  the  investigation  of  the  hospital 
conditions  was  carried  on  with  the  utmost  thor- 
oughness and  conscientiousness.  By  good  fortune 
one  of  the  Commissioners,  General  James  Bowen, 
was  not  of  the  usual  politician  type,  but  a  gentle- 
man and  personal  friend  of  the  visitors.  He  not 
only  assisted  them  with  official  support,  but  begged 
them  to  carry  their  investigations  into  the  other 
city  institutions.  It  was  no  doubt  owing  to  the 
weight  of  his  personal  and  civic  prestige  that  the 
visitors  were  protected  against  the  antagonism  of 
the  petty  politicians  which,  in  the  Westchester 
poorhouse  and  many  other  institutions,  had  been 
freely  displayed  against  them,  even  when  they 
were  women  of  prominence.  Only  this  one  friend 
on  the  Board  of  Commissioners  is  recorded  in  the 
minutes  of  that  institutional  invasion,  and  on  the 
Medical  Board  only  four — Dr.  James  R.  Wood,  Dr. 
Austin  Flint,  Dr.  Stephen  Smith,  and  Dr.  James 


380  A  History  of  Nursing 

M.  Markoe.  To  these  five  men  we  owe  the  initia- 
tion of  reforms  in  hospital  service  in  New  York. 
The  others  were,  if  not  actively  in  opposition,  at 
least  discouraging.  One  of  the  physicians  and 
even  a  clergyman  who  visited  Belle vue  publicly 
expressed  the  opinion  that  the  hospital  was  not  a 
proper  place  for  ladies  to  v4sit,  and  these  criticisms 
illustrate  the  character  of  the  stream  of  disappro- 
bation— social,  political,  and  medical — which  the 
women  had  to  confront  during  that  momentous 
winter. 

In  a  comparatively  short  time,  with  the  strong 
support  of  General  Bowen,  the  visitors  succeeded 
in  making  substantial  improvements  in  the  kitchen, 
laundry,  and  supply  departments ;  but  when  they 
came  to  study  a  systematic  plan  for  the  complete 
reorganisation  of  the  whole  housekeeping  side  of 
the  hospital,  one  and  all  became  convinced  of  the 
utter  hopelessness  of  any  radical  or  lasting  im- 
provement unless  there  was  an  entire  change  in 
the  system  of  nursing.  As  far  back  as  1848  the 
system  of  convict  nursing  had  been,  in  theory  at 
least,  discredited,  and  the  hired  nurses  were  sup- 
posed to  be  selected  from  among  poor  but  repu- 
table women  of  decent  habits.  This  was  an  ideal 
that  could  be  but  rarely  attained,  and  when  the 
visitors  began  their  investigations  they  found  few 
such  women  in  the  whole  building.  Almost  the 
entire  staff  of  female  attendants,  including  the 
"scrub-gang"  which  remained  for  years  after 
the  training  school  was  opened,  was  recruited  from 


A  Trio  of  Training  Schools        3^1 

the  class  of  petty  offenders  who  had  been  "  sent 
up,"  mostly  for  drunkenness,  to  the  Island,  and 
were  called  the  "  ten-day  women. ' '  If  these,  in  the 
hospital  service,  showed  any  willingness  to  remain 
and  keep  sober,  they  were  retained  until  their  next 
"spree,"  and  even  such  accidental  mishaps  were 
often  overlooked  if  the  ''nurses"  were  at  least 
kindly  in  their  feelings  for  the  sick,  and  this  many 
of  them — unless  something  happened  to  arouse 
their  easily  excited  rage  and  violence — really  were. 
But  even  of  these  there  were  no  night  nurses. 
Three  night  watchmen  guarded  the  wards  at  night, 
and  made  rounds  among  the  six  hundred  patients. 
It  is  said  that  they  sometimes  drugged  those  who 
were  likely  to  need  attention,  and  drank  the  stim- 
ulants that  had  been  prescribed.  ^ 

The  visitors  accordingly  passed  a  resolution  in 
April,  1872,  addressed  to  the  Commissioners  of 
Charity  and  begging  them  to  consent  to  consider 
a  plan  which  the  ladies  desired  to  lay  before  them 
for  establishing  a  training  school  for  nurses.  The 
Commissioners  (through  General  Bowen's  influ- 
ence) gave  a  cordial  reception  to  the  ladies'  letter, 
and  answered  it  with  expressions  of  approbation. 
However,  they  deemed  it  necessary  to  refer  the 
plan  to  the  Medical  Board  for  decision.  Time 
went  by,  but  no  reply  came  from  the  Medical 
Board.  Inquiries  were  made,  and  it  was  found 
that  it  had  taken  no  action. 

1  "  A  New  Profession  for  Women,"  Franklin  H.  North. 
The  Century  Magazine,  Nov.  1882,  p.  39. 


382  A  History  of  Nursing 

It  had  already  been  decided  by  the  committee 
that  a  thorough  study  of  training  systems  already 
in  existence  must  be  made,  and  Dr.  Gill  Wylie, 
still  foremost  in  devotion  to  the  cause,  offered  to 
go  to  Europe  at  his  own  expense  and  bring  back  a 
full  report  of  the  status  of  nursing  abroad.  He 
made  his  trip  in  the  summer,  returning  in  the  au- 
tumn, and  brought  with  him  full  and  interesting 
accounts  of  the  Nightingale  school  at  St.  Thomas's, 
of  the  extension  of  the  new  system  into  other  Eng- 
lish hospitals,  of  the  rise  of  district  nursing  and  its 
great  possibilities,  with  a  general  survey  of  the 
nursing  conditions  in  France  and  Germany,  and, 
most  important  of  all,  a  long  letter  of  counsel  and 
encouragement  from  Miss  Nightingale,  to  whom 
he  had  immediately  communicated  his  mission. 

In  view  of  the  silence  of  the  Medical  Board, 
the  Bellevue  Hospital  committee  resolved,  in 
September,  1872,  to  refer  the  whole  matter  to 
the  Hospitals  Committee  of  the  State  Chari- 
ties Aid  Association,  and  this  body  prepared 
a  scheme  for  the  establishment  of  a  training 
school  for  nurses  at  Bellevue,  and  undertook 
further  negotiations  with  the  Medical  Board.  By 
the  efforts  of  the  four  members  of  the  Board 
who  were  friendly  to  the  visitors  and  their  plans — 
Drs.  Wood,  Flint,  Smith,  and  Markoe — a  com- 
mittee from  the  Medical  Board  was  finally  ap- 
pointed to  receive  the  communication.  Three 
days  later  this  committee  presented  the  scheme  to 
the  full  Board,  and  a  unanimous  resolution  was 


A  Trio  of  Training  Schools       383 

passed  expressing  approval  of  its  suggestions, 
and  recommending  it  to  the  Commissioners  of 
Charities.  The  Commissioners  in  turn  considered 
it,  and  finally  agreed — ^though  with  reluctance — to 
give  the  committee  of  ladies  six  wards  in  Bellevue 
for  the  training  of  nurses. ^  The  victory  was  now 
complete.  It  was  an  exciting  winter  in  New  York 
society.  Little  was  talked  of,  in  the  circles 
of  the  members  of  the  State  Charities  Aid, 
but  the  proposed  reforms  and  the  projected 
school  for  nurses.  The  report  of  the  Hospitals 
Committee  of  the  State  Charities  Aid  Associa- 
tion, dated  December  23,  1872,  or  just  two  days 
before  Christmas,  is  a  notable  document  and  one 
which  ought  not  to  be  allowed  to  fall  into  oblivion. 
It  gave  a  most  graphic  survey  of  the  facts  disco^^- 
ered  during  the  visits  to  the  hospitals,  emphasised 
the  shameful  character  of  the  hospital  housekeep- 
ing and  nursing,  noted  the  advance  of  nursing  un- 
der Miss  Nightingale  and  recounted  her  services 
to  humanity,  told  of  Dr.  Wylie's  travels  and  in- 
vestigations, of  the  negotiations  with  the  Medical 
Board  and  their  final  consent,  and  then  proceeded 
to  give  this  inspiring  and  far-sighted  statement  of 
their  aims : 

In  the  plan  offered  for  the  establishment  of  the 
school  at    Bellevue  we  ask  only  for  the  control  and 

>  State  Charities  Aid  Association :  Training  School  for 
Nurses  to  be  attached  to  Bellevue;  report  of  the  Committee 
on  Hospitals.  New  York,  1877.  Called  report  No.  i  in 
bound  volume. 


384  A  History  of  Nursing 

nursing  of  six  wards:  more  than  this  it  would  be  im- 
possible to  attempt  satisfactorily  at  first.  In  course 
of  time  we  propose  to  benefit  not  only  Bellevue,  but 
all  the  public  hospitals,  and  also  to  train  nurses  for  the 
sick  in  private  houses,  and  for  the  work  among  the 
poor. 

As  the  work  advances  we  hope  to  establish  a  col- 
lege for  the  training  of  nurses,  which  will  receive  a 
charter  from  the  State,  and  become  a  recognised  in- 
stitution of  the  country.^  Branches  of  this  college 
would  be  established  in  connection  with  hospitals  de- 
voted to  particular  diseases,  such  as  the  Woman's 
hospital,  etc.,  so  that  in  course  of  time  nurses  trained 
for  the  treatment  of  special  diseases  will  be  as  easily 
attainable  as  physicians.  Connected  with  the  college 
would  be  a  "Home"  for  nurses,  w^hence  they  would 
be  supplied  with  employment  and  provision  made  for 
them  when  ill  or  disabled  by  labour  or  advanced  years. 
The  nurses  when  trained  would  receive  a  diploma  or 
certificate,  renewable  at  fixed  periods.  Thus  the  col- 
lege would  control  the  nurses  during  their  state  of 
pupilage,  and  protect  the  public  from  imposition,  by 
making  it  known  that  a  nurse  whose  diploma  or  certif- 
icate was  not  in  due  form  had  forfeited  the  confidence 
of  the  institution. 

The  work  before  us  is  not  an  inexpensive  one.  It 
should  not  be  regarded  merely  in  the  light  of  a  work 
of  benevolence,  but  as  a  system  of  education,  calcu- 
lated to  benefit  thousands  in  all  ranks  of  life,  and,  like 
the  quality  of  mercy,  blessing  him  that  gives  and  him 
that  takes. 

We  require  at  present  the  sum  of  $20,000.     A  house 

J  The  school  became  incorporated  in  1874. 


A  Trio  of  Training  Schools        385 

must  be  had  for  the  Lady  Superintendent  and  nurses : 
not  a  mere  lodging,  but  a  comfortable  home,  where, 
after  their  daily  labours,  they  may  find  relaxation  and 
rest,  free  from  the  depressing  influences  of  the  hospital. 
Our  head  nurses,  on  whom  will  devolve  the  task  of 
training  the  probationers,  will  be  entitled  to  the  high 
wages  they  would  receive  in  private  houses.  To  the 
probationers  we  shall  give  moderate  wages,  on  a  rising 
scale,  in  proportion  to  their  usefulness  and  term  of 
service. 

The  money  which  may  now  be  intrusted  to  us  will 
be  placed  in  the  hands  of  a  committee,  chosen  from  the 
members  of  the  Bellevue  Association — persons  of  ex- 
perience, who  will  devote  themselves  conscientiously 
to  the  work  they  undertake.  The  Lady  Superintend- 
ent will  go  to  England,  and  make  herself  acquainted 
with  all  the  details  of  her  duties,  at  St.  Thomas's  hos- 
pital and  at  the  Liverpool  infirmary.  Our  head 
nurses  will  be  chosen  with  the  utmost  care,  and  the 
physicians  and  surgeons  of  Bellevue  have  offered 
not  only  to  deliver  lectures,  but  to  give  personal  in- 
struction by  the  bedside  of  the  patients ;  and  the  Com- 
missioners of  Charities  have  testified  a  most  ready 
willingness  to  co-operate  in  our  work.  Under  such 
auspices  we  feel  confident  that  we  shall  achieve  the 
same  success  that  has  already  been  attained  in  Eng- 
land, if  we  receive,  at  the  outset,  sufficient  funds  to 
enable  us  towork  without  being  constantly  trammelled 
by  pecuniary  considerations.'  It  will  be  seen  by  Dr. 
Wylie's  report  that  the  nurses  trained  in  England  are 
chiefly  recruited  from  the  class  of  upper  servants.     In 

>  Six  weeks  after  the  publication  of  this  report  the  sum  of 
$23,000  was  contributed. 

VOL.  II.— 25 


386  A  History  of  Nursing 

this  country,  women  of  that  class  find  plenty  of  em- 
ployment at  high  wages;  we  propose,  therefore,  to  of- 
fer the  advantages  of  our  school  to  women  of  a  higher 
grade. ^  In  this  country  we  have  a  large  class  of  con- 
scientious and  laborious  women  whose  education  and 
early  associations  would  lead  them  to  aspire  to  some 
higher  and  more  thoughtful  labour  than  household 
service  or  work  in  shops:  such  as  daughters  and  wid- 
ows of  clergymen,  professional  men  and  farmers 
throughout  New  England  and  the  Northern  States, 
who  have  received  the  good  education  of  our  common 
schools  and  academies,  and  are  dependent  on  their 
own  exertions  for  support.  An  American  woman, 
with  such  an  education,  and  her  heart  in  the  work, 
could  be  trained  to  make  the  best  ntirse  in  the  world, 
for  the  race  has  ready  wit,  quick  perception,  and 
strong  powers  of  observation.  Let  her,  in  addition 
to  these  qualities,  acquire  the  habit  of  obedience  and 
you  have  all  the  elements  for  making  a  good  nurse. 
To  such  women  we  are  prepared  to  offer  a  career  of 
the  widest  usefulness:  a  profession  acquired  under 
masters  of  the  highest  skill  (physicians  and  surgeons 
of  not  onl}^  American  but  of  European  fame)  and  an 
assured  means  of  livelihood.  There  is  an  idea  pre- 
vailing among  certain  classes  that  the  work  of  nursing 
can  best  be  done  by  persons  who  receive  no  pay, 
but  simply  a  support  from  the  order  to  which  they 
belong — that  the  receipt  of  money  gives  the  stigma 
of  servility  to  the  work.  While  we  would  not  in  any 
way  depreciate  the  usefulness  of  those  holding  these 
views,  we  feel  that  the  idea  is  an  erroneous  one:  that 

»  Women  of  the  class  here  alluded  to  are  now  obtained 

without  dilfiCultv. 


A  Trio  of  Training  Schools        387 

such  a  rule  shuts  out  a  vast  number  whose  services 
would  be  invaluable. 

Why  should  not  Christian  women  receive  proper 
remuneration  for  their  services  as  well  as  Christian 
men?  Does  not  our  Divine  Master  tell  us  that  "the 
labourer  is  worthy  of  his  hire  "  ? 

Candidates  for  this  work  must  not  blind  themselves 
to  its  difficulties.  In  the  wards  of  a  pauper  hospital 
they  must  come  into  daily  contact  with  vice  and  dis- 
ease in  their  most  repulsive  forms;  deeply  graven  on 
their  hearts,  and  reflected  in  their  lives,  must  be  the 
words  of  St.  Paul:  "Charity  suffereth  long  and  is 
kind;  charity  envieth  not;  charity  vaunteth  not  it- 
self, is  not  puffed  up,  doth  not  behave  itself  unseemly, 
seeketh  not  her  own,  is  not  easily  provoked,  thinketh 
no  evil;  rejoiceth  not  in  iniquity,  but  rejoiceth  in  the 
truth;  beareth  all  things,  believeth  all  things,  endureth 
all  things." 

We  wish  our  candidates  to  be  religious  women,  but 
we  do  not  require  that  they  should  belong  to  any 
given  sect.  To  Catholic  and  Protestant  our  doors  are 
equally  open;  we  impose  no  vows;  we  say  to  all,  in 
the  words  of  the  holy  founder  of  the  order  of  the  Sis- 
ters of  Charity:  "Your  convent  must  be  the  houses 
of  the  sick;  your  cell  the  chamber  of  suffering;  your 
chapel  the  nearest  church;  your  cloister  the  streets 
of  a  city,  or  the  wards  of  a  hospital;  the  promise  of 
obedience  your  sole  enclosure;  your  grate  the  fear  of 
God,  and  womanly  modesty  your  only  veil." 
For  the  Committee  on  Hospitals, 

Elizabeth  Hobson, 

Chairman. 

All  obstacles  being  removed,  a   subcommittee 


388  A  History  of  Nursing 

was  appointed  to  prepare  a  working  plan  for  the 
projected  school  and  to  deal  with  all  of  the  prelim- 
inary details  of  its  organisation.  This  committee  ^ 
which  dealt  so  brilliantly  and  ably  with  the  respon- 
sibility entrusted  to  it,  and  achieved  a  success  that 
has  completely  revolutionised  the  care  of  the  sick 
in  the  New  World,  was  composed  of  the  follow- 
ing members:  Mrs.  W.  H.  Osbom,  chairman; 
Mrs.  Robert  Woodworth,  secretary;  Mrs.  Wm. 
Preston  Griffin,  Mrs.  d'Oremieulx,  Mrs.  Joseph 
Hobson,  Miss  Woolsey,  Miss  Ellen  Collins,  Miss 
Julia  Gould,  Mr.  Henry  G.  Stebbins,  treasurer; 
Dr.  W.  G.  Wylie,  Mr.  Chandler  Robbins.  Theii' 
years  of  devoted  and  untiring  service  can  never 
be  too  highly  estimated,  and  their  names  will 
claim  the  gratitude  and  recognition  of  future 
generations . 

Miss  Nightingale's  letter  to  Dr.  Wylie  proved  to 
be  a  strong  support  to  the  women  in  their  experi- 
ment. Omitting  some  purely  personal  details  of 
explanation  for  not  having  been  able  to  receive 
him,  the  letter  ran  as  follows : 

I  wish  your  association  God-speed  with  all  my 
heart  and  soul  in  their  task  of  reform,  and  will  gladly, 
if  I  can,  answer  any  questions  you  may  think  it  w^orth 
while  to  ask. 

You  say  "the  great  difficulty  will  be  to  define  the 
instructions,  the  duties,  and  position  of  the  nurses 
in  distinction  from  those  of  medical  men,  and  you  are 
anxious  to  get  my  views  in  relation  to  this  subject." 

Is  this  a  difficulty?  A  nurse  is  not  a  "medical  man." 


A  Trio  of  Training  Schools        389 

Nor  is  she"a  medical  woman.  (Most  carefully  do  we, 
in  our  training,  avoid  confusion,  both  practically  and 
theoretically,  of  letting  women  suppose  that  nursing 
duties  and  medical  duties  run  into  or  overlap  each 
other;  so  much  so  that,  though  we  often  have  been 
asked  to  allow  ladies  intending  to  be  "Doctors"  to 
come  in  as  nurses  to  St.  Thomas's  hospital,  in  order  to 
"pick  up" — so  they  phrased  it — professional  medical 
knowledge,  we  have  never  consented  even  to  admit 
such  applications,  in  order  to  avoid  even  the  sem- 
blance of  encouraging  such  gross  ignorance,  and  dab- 
bling in  matters  of  life  and  death,  as  this  implies.  You 
who  are  a  "medical  man,"  who  know  the  difference  be- 
tween the  professional  studies  of  the  medical  student, 
even  the  idlest,  and  of  the  nurse,  will  readily  see  this.) 
Nurses  are  not  "medical  men."  On  the  contrary,  the 
nurses  are  there,  and  solely  there,  to  carry  out  the  orders 
of  the  medical  and  surgical  staff,  including,  of  course, 
the  whole  practice  of  cleanliness,  fresh  air,  diet,  etc. 
The  whole  organisation  of  discipline  to  which  the 
nurses  must  be  subjected  is  for  the  sole  purpose  of 
enabling  the  nurses  to  carry  out,  intelligently  and 
faithfully,  such  orders  and  such  duties  as  constitute 
the  whole  practice  of  nursing.  They  are  in  no  sense 
medical  men.  Their  duties  can  never  clash  with  the 
medical  duties.  Their  whole  training  is  to  enable 
them  to  understand  how  best  to  carry  out  medical 
and  surgical  orders,  including  (as  above)  the  whole 
art  of  cleanliness,  ventilation,  food,  etc.,  and  the  reason 
why  this  is  to  be  done  this  way  and  not  that  way. 

And  for  this  very  purpose — that  is,  in  order  that 
they  may  be  competent  to  execute  medical  direc- 
tions— ^to  be  nurses  and  not  doctors — they  must  be, 
foi  discipline  and  internal  management,  entirely  under 


390  A  History  of  Nursing 

a  woman,  a  trained  superintendent,  whose  whole  busi- 
ness is  to  see  that  the  nursing  duties  are  performed 
according  to  this  standard.  For  this  purpose  may  I 
say: 

1.  That  the  nursing  of  hospitals,  including  the 
carrying  out  of  medical  officers'  orders,  must  be  done 
to  the  satisfaction  of  the  medical  officers  whose  orders 
regarding  the  sick  are  to  be  carried  out.  And  we  may 
depend  upon  it  that  the  highly  trained  intelligent 
nurse,  and  cultivated  moral  woman,  will  do  this  better 
than  the  ignorant,  stupid  woman,  for  ignorance  is 
always  headstrong. 

2.  That  all  desired  changes,  reprimands,  etc.,  in 
the  nursing  and  for  the  nurses,  should  be  referred  by 
medical  officers  to  the  superintendent. 

That  rules  which  make  the  matron  (superintend- 
ent) and  nurses  responsible  to  the  house  surgeons,  or 
medical  and  surgical  staffs,  except  in  the  sense  of 
carrying  out  current  medical  orders,  above  insisted 
on,  are  always  found  fatal  to  nursing  discipline. 

That  if  the  medical  officers  have  fault  to  find,  it  is 
bad  policy  for  them  to  reprimand  the  nurses  them- 
selves. The  medical  staff  must  carry  all  considerable 
complaints  to  the  matron;  the  current  complaints, 
as,  for  instance,  if  a  patient  has  been  neglected,  or  an 
order  mistaken,  to  the  ward  "Sister,"  or  the  head 
nurse,  who  must  alzvays  accompany  the  medical  officer 
in  his  visits,  receive  his  orders,  and  be  responsible  for 
their  being  carried  out. 

(All  considerable  complaint  against  a  head  nurse, 
or  "  Sister,"  to  go,  of  course,  to  the  matron.) 

3.  All  discipline  must  be,  of  course,  under  the  ma- 
tron (superintendent)  and  ward  "Sisters,"  otherwise 
nursing  is  impossible. 


A  Trio  of  Training  Schools        391 

And  here  I  should  add  that,  unless  there  is,  so  to 
speak,  a  hierarchy  of  women — as  thus:  matron  or 
superintendent,  Sisters  or  head  nurses,  assistant  or 
night  nurses,  wardmaids  or  scrubbers  (or  whatever 
other  grades  are,  locally,  considered  more  appro- 
priate)— discipline  becomes  impossible. 

In  this  hierarchy  the  higher  grade  ought  always  to 
know  the  duties  of  the  lower  better  than  the  lower 
grade  does  itself.  And  so  on  to  the  head.  Other- 
wise, how  will  they  be  able  to  train?  "Moral  influ- 
ence" alone  will  not  make  a  good  trainer. 

Any  special  questions  which  you  may  like  to  address 
to  me  I  will  do  my  best  to  answer  as  well  as  I  am  able. 

But  I  am  afraid  that,  without  knowing  your  special 
case,  I  shall  be  only  confusing  if  I  add  much  more 
now. 

I  will,  therefore,  only  now  mention,  as  an  instance, 
that  the  very  day  I  received  your  first  message 
(through  Mrs.  Wardroper)  I  received  a  letter  from  a 
well-known  German  physician  strikingly  exemplify- 
ing what  we  have  been  saying  as  to  the  necessity  of 
hospital  nurses  being  in  no  way  under  the  medical 
staff  as  to  discipline,  but  under  a  matron  or  "lady 
superintendent"  of  their  own,  who  is  responsible  for 
the  carrying  out  of  medical  orders. 

You  are,  doubtless,  aware  that  this  is  by  no  means 
the  custom  in  Germany.  (In  France  the  system  much 
more  nearly  approaches  to  our  own.)  In  Germany, 
generally  the  ward  nurse  is  immediately,  and  for  every- 
thing under  the  ward  doctor.  And  this  led  to  conse- 
quences so  disastrous  that,  going  into  the  opposite 
extreme,  Kaiserswerth  and  other  German  Protestant 
deaconesses'  institutions  were  formed,  where  the  chap- 
lain and  the  "  Vorsteherin "  (female  superintendent) 


392  A  History  of  Nursing 

were,  virtually,  masters  of  the  hospital,  which  is  of 
course  absurd. 

My  friend,  then,  who  has  been  for  forty  years  med- 
ical officer  of  one  of  the  largest  hospitals  in  Germany, 
wrote  to  me  that  he  had  succeeded  in  placing  a  matron 
over  his  nurses;  then,  after  one  and  a  half  year,  she 
had  been  so  persecuted  that  she  had  been  compelled 
to  resign;  then,  that  he  had  remained  another  year 
trying  to  have  her  replaced;  lastly  that,  failing,  he 
had  himself  resigned  his  post  of  forty  years,  believing 
that  he  could  do  better  work  for  his  reform  outside 
the  hospital  than  in  it. 

It  seems  extraordinary  that  this  first  essential,  viz., 
that  women  should  be,  in  matters  of  discipline,  under  a 
woman,  should  need  to  be  advocated  at  all.  But  so  it  is. 

And  I  can  add  my  testimony,  as  regards  another 
vast  hospital  in  Germany,  to  the  abominable  effects  of 
nurses  being  directly  responsible  not  to  a  matron,  but 
to  the  economic  staff  and  medical  staif  of  their  hos- 
pital. And  I  am  told,  on  the  highest  authority,  that 
since  my  time  things  have  only  got  worse. 

But  I  will  not  take  up  your  time  and  my  own  with 
more  general  remarks,  which  may  not  prove,  after  all, 
applicable  to  your  special  case. 

But  I  think  I  will  venture  to  send  you  a  copy  of  a 
paper — the  only  one  I  have  left.  The  original  was 
written  by  order  of  the  (then)  Poor-Law  Board,  for 
their  new  workhouse  infirmaries,  and  printed  in  their 
reports.  So  m.any  hospitals  then  wrote  to  me  to  give 
them  a  similar  sketch  for  their  special  use,  and  it  was 
so  utterly  impossible  for  me  to  write  to  all,  that  I 
abridged  and  altered  my  original  paper  for  their  use. 
And  this  (I  fear  dirty)  copy  is  the  last  I  have  left. 
Pray  excuse  it. 


A  Trio  of  Training  Schools        393 

Again  begging  you  to  command  me,  if  I  can  be  of 
any  use  for  your  great  purpose,  to  which  I  wish  every 
success  and  ever-increasing  progress,  pray  beUeve  me, 
Sir,  Ever  your  faithful  servant, 

Florence  Nightingale. 

P.  S.  You  will  find  in  the  appendix  to  the  printed 
paper  all  the  steps  of  our  training  at  St.  Thomas's  hos- 
pital, under  our  admirable  matron,  Mrs.  Wardroper; 
but  as  she  may  probably  see  this  letter,  I  must  abstain 
from  praising  her,  as  it  were,  "to  her  face,"  which  all 
noble  natures  dislike.  F.  N. 

Fortified  by  the  counsel  and  encouragement  of 
Miss  Nightingale,  the  appeal  to  the  Nev^  York 
public  previously  quoted  from  was  issued  by  the 
committee,  with  the  gratifying  response  of  funds 
as  mentioned,  and  the  committee  agreed  to  be  in 
readiness  to  open  the  training  school  on  the  first 
of  May.  A  house  was  rented  near  the  hospital  as 
a  home  for  nurses,  circulars  were  issued  inviting 
pupils  to  apply,  and  search  was  made  for  a  super- 
intendent. Time  passed  and  no  suitable  person 
for  this  post  was  found,  and  the  committee,  with 
much  anxiety,  saw  the  first  of  May  approaching. 
We  may  borrow  from  the  managers'  later  account 
the  pretty  little  anecdote  of  how  this  uncertainty 
was  ended: 

A  member  of  the  committee,  in  a  despondent 
mood,  at  this  time  expressed  her  anxiety  to  another, 
who  repHed,  "I  have  such  faith  in  this  work,  and  I 
have  prayed  so  for  it,  that  I  shall  have  that  superin- 
tendent's bed  made,  being  sure  that  she  will  come  to 


394  A  History  of  Nursing 

occupy  it."  A  few  days  later  the  former  lady  was  at 
her  breakfast  table  when  a  woman  in  the  garb  of  a 
Sister  was  announced.  Her  English  accent  betrayed 
her  nationality  as  she  explained  that  she  had  heard 
we  were  establishing  a  training  school  for  nurses 
in  New  York,  and,  as  she  had  had  considerable 
experience  in  such  work,  she  had  come  to  offer  her 
services.  ^ 

This  was  Miss  Bowden,  known  as  Sister  Helen,  of 
All  Saints  Sisterhood,  of  London  and  Baltimore  (for 
a  branch  of  the  community  had  been  established 
in  the  latter  city,  and  Sister  Helen  had  been  in 
residence  there  when  the  circulars  and  inquiry  for 
a  superintendent  had  been  published),  who  had 
been  trained  in  University  College  hospital,  London, 
where  she  was  distinguished  as  a  fine  medical 
nurse,  an  excellent  teacher,  and  effective  adminis- 
trator. Having  some  time  at  her  disposal  before 
returning  to  England,  she  had  come  to  New  York 
to  propose  undertaking  the  new  work.  Sister 
Helen  was  engaged  without  delay,  and  the  school 
opened  according  to  promise  on  the  first  of  May, 
in  five  wards.  It  is  easy  to  imagine  what  the 
difficulties  must  have  been,  but  since  matters 
turned  out  well  they  have  been  forgotten.  The 
managers'  history  says: 

At  the  expiration  of  the  first  year  the  house  med- 
ical staff,  who  had  been  friendly  from  the  beginning, 
ventured  to  point  out  to  their  superiors  the  improved 

J  History  of  the  Establishment  of  the  Bellevtie  Training  School 
for  Nurses,  cit.,  pp.  5-6. 


Sister  Helen  of  All  Saints'  First  Superintendent  of  the  New  York  Traininj;  School 
for  Nurses  Connected  with  Bellevue  Hospital 


A  Trio  of  Training  Schools        395 

condition  of  the  nursing  service  under  the  training 
school,  and  gradually  the  eyes  of  these  gentlemen 
were  opened  to  the  fact  that  their  patients  recovered 
sooner,  and  the  deaths  after  operations  were  less  fre- 
quent, than  formerly.  The  superintendent.  Sister 
Helen,  accustomed  to  the  management  of  a  pauper 
hospital  in  England,  and  to  deal  with  workhouse  au- 
thorities, was  not  daunted  by  the  politics  of  Bellevue, 
so,  gradually,  during  the  second  year  the  work  as- 
sumed permanent  shape  and  was  extended  to  other 
wards.  The  applications  from  would-be  pupils  in- 
creased; the  first  pupils  became  head  nurses,  and  at 
the  close  of  the  second  year  the  first  class 
graduated. 

During  1874  four  more  wards  were  given  over  to 
the  school,  making  nine  in  charge  of  the  nurses. 
The  indebtedness  of  Bellevue,  and  through  it  of 
the  nursing  profession  generally  in  the  United 
States,  to  Sister  Helen  can  hardly  be  too  warmly 
acknowledged,  and  it  can  only,  indeed,  be  properly 
estimated  by  looking  back  upon  it  from  the  pres- 
ent time.  A  strong  and  dominant  character,  of 
marked  executive  ability  and  thorough  mistress  of 
her  domain,  she  laid  the  firm  foundations  upon 
which  the  Bellevue  school  has  stood  unshaken  all 
these  years.  Her  first  and  unvarying  position  w^as 
to  exact  respect  and  consideration  for  the  nurses 
from  every  one  in  the  hospital,  as  she  demanded 
deference  for  herself.  A  bulky  and  imposing  fig- 
ure in  her  religious  garb,  of  heavy  and  prelate-like 
countenance,  her  chief  personal  charm  was  a  voice 
of  unusual  sweetness  and  refinement  of  enuncia- 


39^  A  History  of  Nursing 

tion.  A  strict  disciplinarian,  she  loved  to  rule, 
but  she  ruled  wisely.  She  was  not  lavish  of  praise, 
even  to  those  she  most  valued,  yet  after  searching 
criticism  or  severe  admonition  she  knew  how  to 
administer  the  sweet  with  the  bitter  by  commenda- 
tion, and  no  faithful  efforts  escaped  her  notice. 
Of  strong  and  very  positive  opinions,  she  was  not 
without  egoism  and  sometimes  failed  in  tactful 
conciliation.  A  religious  woman,  and  a  thor- 
oughly good  woman,  she  was  not  easily  under- 
stood, and  few  reached  her  innermost  confidence, 
but  those  who  did  so  gave  her  steadfast  affection 
and  loyalty.  She  in  turn  was  loyal  to  her  nurses, 
protected  them,  and  inspired  them  with  a  full 
sense  of  the  gravity  of  their  responsibilities.  A 
certain  jealousy  is  the  natural  complement  of 
forceful  natures,  and  this  was  not  absent  with 
Sister  Helen,  though  it  was  for  her  work  more 
than  for  herself,  unless  one  might  say  that  her 
work  w^as  herself. 

Fortunately  for  the  school  the  warden  at  that 
time  became  a  firm  friend  of  Sister  Helen  and 
the  nurses  and  it  was  his  wont  to  send  them 
warnings  when  skirmishes  with  the  enemy 
(in  the  shape  of  unfriendly  politicians)  were 
likely  to  be  expected.  These  worthies,  who 
had  once  accepted  so  indifferently  the  bad  condi- 
tions of  Belle vue,  were  now  keen  to  inspect  the 
nurses'  wards  and  alert  to  find  causes  for  criti- 
cism. One  of  the  first  class  of  nurses  has  told  of 
the  rounds  thev  used  to  make  in  the  bath-rooms 


A  Trio  of  Training  Schools        397 

and  corners,  even  wiping  the  walls  with  their 
hands  to  see  if  any  dust  could  be  found. 

Bellevue  also  owed  a  debt  to  the  school  of  the 
New  England  hospital,  for  this  pioneer  institution 
sent  it  two  head  nurses,  Mrs.  Wolhaupter  and  Miss 
Woods  and  a  night  superintendent,  Miss  Richards, 
from  its  first  class  of  graduates.  Miss  Richards, 
whose  reminiscences  cover  the  whole  early  field  of 
nursing,  came  to  Bellevue  from  her  alma  mater  on 
the  first  of  October,  when  the  school  was  only  five 
months  old.  After  a  day  or  two  in  the  wards  she 
was  put  in  charge  at  night,  with  the  following  in- 
structions from  Sister  Helen:  ''You  are  to  see 
each  head  nurse  before  she  leaves  for  the  night, 
and  take  her  orders;  you  are  to  send  all  calls  to 
the  physicians,  give  all  medicines,  take  personal 
care  of  all  seriously  ill  patients,  instruct  the  nurses 
in  their  duties  every  hour,  and  report  to  each  head 
nurse  before  going  off  duty  in  the  morning."  The 
school  then  had  five  wards  and  about  one  hundred 
patients.  Reports  and  orders  were  all  verbal  and 
it  was  through  Miss  Richards 's  notes  of  a  case, 
written  to  help  one  of  the  day  nurses  in  the  note- 
taking  required  of  the  pupils  by  Sister  Helen, 
that  the  system  of  written  day  and  night  reports 
and  orders  came  about;  for  one  of  the  physicians, 
finding  the  written  record  of  the  night  for  one  pa- 
tient, was  so  pleased  with  it  that  no  time  was 
lost  in  establishing  the  rule  of  written  reports 
throughout. 

The  managers    of    the    school   had    from  the 


398  A  History  of  Nursing 

outset  accepted  Miss  Nightingale's  principles  as  to 
the  internal  organisation  and  discipline  necessary. 
They  say  on  this  point : 

The  principle  which  Miss  Nightingale  insisted 
upon  as  fundamental  and  which  excited  the  greatest 
opposition  among  hospital  authorities  was  that  all 
nurses  should  in  matters  of  discipline  be  under  a  wo- 
man, who  should  be  responsible  to  the  hospital  author- 
ities for  the  behaviour  of  her  subordinates,  and  for  the 
faithful  performance  of  their  duties;  that  all  com- 
plaints should  go  to  her  to  be  investigated,  and  be  by 
her  referred  to  the  supreme  authority,  whether  warden 
or  medical  superintendent.  This  was  such  an  innova- 
tion in  hospital  rule  that  it  created  great  opposition 
at  first  in  this  country  as  well  as  in  Europe;  but, 
following  the  advice  of  Miss  Nightingale,  the  commit- 
tee stood  firm,  carried  their  point,  and  as  time  passed 
and  the  school  extended,  until  it  controlled  all  the 
musing  in  the  hospital,  the  rule  was  accepted  without 
a  question,  and  as  other  schools  were  founded  the 
superintendents  carried  these  rules  w^ith  them,  until 
now  no  other  system  is  in  use  in  any  hospitals  in  Eng- 
land, nor  in  civil  hospitals  in  this  country. 

In  other  details  of  form,  however,  the  committee 
did  not  aim  to  follow  closely  the  English  model, 
but  developed  on  their  own  lines  in  accordance 
with  the  differences  in  our  social  structure.  Most 
important  of  these  modifications  was  the  definite 
and  intentional  exclusion  of  the  domestic  servant 
class  and  the  determination  to  offer  the  training 
only  to  those  women  who  had  had  better  educa- 
tional advantages.     This   decision,    which   is  set 


A  Trio  of  Training  Schools        399 

forth  in  the  above-quoted  report  of  the  committee 
of  which  Mrs.  Hobson  was  chairman,  is  one  of  the 
things  for  which  w^e  have  to  feel  most  grateful,  for 
it  has  prevented  the  caste  lines  which  have  proved 
such  practical  hindrances  and  obstacles  to  progress 
in  some  of  the  Old-World  institutions ,  set  the  gene- 
eral  standard  (with  some  few  exceptions)  for  the 
whole  country,  and  supplied  our  hospitals  with  a 
set  of  women  of  fairly  similar  aims  and  ideals,  who 
are  enabled  to  act  together  with  unanimity  and 
good  feeling  not  otherwise  possible.  It  is  not  too 
much  to  say  that  the  comparative  homogeneity 
of  the  nursing  profession  thus  attained  has  facilita- 
tated  an  educational  advance  which  has  been  of 
distinct  service  to  the  whole  cause  of  primary  edu- 
cation and  technical  training.  This  wise  and  far- 
sighted  idea,  contemplating  not  only  the  reform  of 
the  hospital,  but  also  the  opening  of  new  avenues 
of  self-support  to  educated  women,  originated 
with  Mrs.  Hobson,  whose  whole  work  on  the  com- 
mittee was  of  an  eminently  constructive  character. 
Another  variation  from  the  English  model  was  the 
shorter  course.  As  at  St.  Thomas's,  here  too  the 
training  was  regarded  as  complete  in  one  year; 
that  is,  instruction  was  not  continued  after  that 
period,  but  the  nurse  was  only  bound  by  contract 
for  one  year's  service  after  the  training  year,  mak- 
ing practically  a  two-years'  course  before  she 
received  her  certificate  and  left  the  school.  A  fur- 
ther difference  was  in  the  complete  exodus  of 
pupils  at  the  end  of  their  course  of  training,  for  our 


400  A  History  of  Nursing 

hospitals  did  not  offer  paid  positions  to  head 
nurses  and  seniors,  but  relied  almost  entirely  on 
the  service  given  in  exchange  for  training; 
finally,  a  marked  difference  from  all  Continental 
schools,  and  from  those  English  ones  that  had  fol- 
lowed St.  Thomas's,  was  in  the  entire  and  recog- 
nised independence,  after  training,  of  the  nurse, 
who  then  ceased  to  be  under  the  guardianship  of 
her  school  except  in  so  far  as  she  might  depend 
upon  it  for  calls  to  private  cases.  For  this  ser- 
vice she  paid  the  school  a  registry  fee,  but  lived 
where  she  pleased  and  received  her  earnings  her- 
self, in  contradistinction  to  the  English  nurse,  who 
joined  a  private  staff  and  received  a  home  and 
salary,  while  her  earnings  went  to  the  school  or 
association  or  hospital.  While  each  of  the  Amer- 
ican variations  had  some  advantages  and  some 
drawbacks,  we  shall  not  now  enter  into  them,  but 
leave  their  consideration  for  another  time.^ 

The  discipline  and  semi-military  atmosphere 
which  came  so  naturally  in  countries  accustomed 
to  nursing  orders  developed  slowly  in  the  early 
American  schools.  The  idea  of  a  uniform  was  not 
liked  by  the  women  who  first  responded  to  the  call 
to  take  up  hospital  nursing,  and  it  w^as  not  at  once 
adopted.  The  members  of  the  committee  under- 
stood very  w^ell  the  moral  effect  of  uniform,  for 

»  From  the  first  the  managers  had  hoped  to  train  nurses 
for  the  service  of  the  poor  in  their  homes,  and  in  March, 
1876,  the  first  district  nurse  from  Belle vue,  supported  by  one 
of  the  managers,  joined  the  Woman's  Branch  of  the  City 
Mission  for  this  service. 


A  Trio  of  Training  Schools        401 

they  had  said  in  the  report  already  quoted :  "A 
uniform,  however  simple,  is  indispensable,  and 
should  be  rigidly  enforced.  It  is  advantageous 
on  the  ground  of  economy  as  well  as  neatness,  and 
its  effect  on  a  corps  of  nurses  is  the  same  as  on  a 
company  of  soldiers."  But  the  practical  diffi- 
culty was,  how  to  introduce  this  idea  into  the 
minds  of  the  probationers;  for,  when  all  was  so 
experimental  and  when  everything  depended  on 
inducing  the  right  class  of  women  to  come  forward, 
it  was  inadvisable  to  insist  upon  a  uniform  in  the 
face  of  their  prejudices  against  it.  In  the  first 
class  of  nurses  was  a  daughter  of  an  old  and  promi- 
nent New  York  family,  on  intimate  terms  w4th  the 
different  members  of  the  committee  and  compre- 
hending the  situation  from  their  point  of  view. 
She  was  also,  by  good  fortune,  very  beautiful,  tall, 
and  dignified.  She  talked  the  matter  over  with 
some  of  the  committee,  and  probably  also  with 
Sister  Helen,  and  it  was  arranged  that  she  should 
have  a  couple  of  days'  leave  of  absence.  On  her 
return  she  made  her  appearance  in  the  wards 
dressed  in  the  greyish-blue  stripe  and  with  apron 
and  cap  of  white.  So  charming  was  she  to  behold, 
and  so  dowdy  and  insignificant  did  all  the  non- 
descript print  dresses  look  beside  her,  that  pre- 
judice vanished  and  as  rapidly  as  possible  the 
uniform  was  adopted,  and  never  again  questioned. 
It  would  perhaps  be  too  much  to  claim  that  it  was, 
in  those  days,  always  absolutely  uniform,  for  we 
seem  to  gather  the  hint  of  an  overskirt  in  the  very 

VOL.  II. — 26. 


402  A  History  of  Nursing 

charming  figure  of  a  nurse  sketched  from  life  in 
the  next  decade,  and  used  to  illustrate  an  article 
dealing  with  the  new  occupation  for  women.  The 
dress  for  winter  and  summer  varied  at  first,  for  the 
fourth  annual  report,  January,  1877,  says  on  this 
point:  "The  pupils  are  required  to  wear  the  dress 
of  the  institution,  viz.,  a  grey  stuff  dress  in  winter 
and  calico  in  summer,  simply  made,  a  white  apron 
and  cap,  and  brown  linen  cuffs  covering  the  sleeves 
from  the  wrist  to  the  elbow. ' '  The  grey  stuff  dress 
for  winter  was  abolished  in  1880. 

The  regeneration  of  the  old  hospital  was  not  yet 
complete.  There  remained  one  department — the 
most  important  of  all — where  the  worst  possible 
conditions  prevailed.  This  was  the  maternity 
division.  As  had  earlier  been  the  case  in  King's 
College  hospital  in  London,  and  still  earlier  in  the 
Hotel-Dieu  of  Paris,  the  practical  management  of 
this  service  had  not  been  brought  up  to  the  point 
of  corresponding  with  the  teachings  of  medical 
science.  The  commonest  stupidity  of  our  civil- 
isation is  the  failure  to  bring  well-known  scien- 
tific principles  into  daily  practice  as  hygienic  and 
sanitary  measures,  and  this  discrepancy  between 
w^hat  is  taught  and  what  is  done  existed  in 
the  maternity  departm.ent  of  Bellevue.  It 
had  long  been  known  to  medical  science  that 
proximity  to  surgical  wards  was,  for  parturient 
patients,  a  most  dangerous  situation.  An  extens- 
ive literature  existed  on  this  subject,  of  which 
Miss  Nightingale's  work,  previously  referred  to. 


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"  The  Nurse" 

Isabel  A.  Hampton,  Bellevue,  18S2 

Sketched  from  life  for  the  Cevtury  Magazine,  Nov.,  1882,  in  "A  New  Profession  for 

Women  " 


A  Trio  of  Training  Schools       403 

was  one  of  the  most  definite  and  practical.  Nu- 
merous scientific  medical  works  were  extant  that 
pointed  out  the  dangers  of  surgical  poison  for  the 
lying-in  woman;  in  fact,  the  references  on  this 
point  had  previously  been  enriched  by  the  writings 
of  a  distinguished  Belle vue  physician,  who  had 
explicitly  stated,  in  opening  his  subject,  that  sur- 
gical poison  was  almost  surely  fatal  to  the  partu- 
rient woman. 

Yet,  in  spite  of  the  teachings  and  warnings  of 
scientific  men,  the  maternity  wards  of  Bellevue 
were  situated  directly  above  the  surgical  wards, 
and  communicated  freely  with  the  latter  by  pub- 
lic stairways  and  corridors.  No  attempt  at  all 
was  made  to  isolate  them;  on  the  contrary  this 
service  was  attached  both  to  the  medical  and  sur- 
gical services,  so  that  the  same  set  of  house-phy- 
sicians or  surgeons — who  were  young  men  just 
out  of  the  medical  school  and  taking  their  hospital 
training — ^went  freely  back  and  forth  from  one  to 
the  other.  The  study  of  bacteriology  was  still 
elementary,  and  the  rounds  from  the  operating 
table,  the  dissection  room,  the  bedsides  of  patients 
fresh  from  the  hovels  of  the  city,  and  the  obstetri- 
cal wards  were  carried  on  without  an  attempt  to 
separate  one  from  the  other.  So  easy  is  it  for 
those  who  are  directly  absorbed  in  the  scientific 
and  abstract  to  forget  the  practical  application 
and  care  of  details. 

The  managers  of  the  school  had  the  practical 
results  brought  to  them  in  a  painful  way  one  win- 


404  A  History  of  Nursing 

ter,  for  puerperal  fever  spread  from  Bellevue  into 
the  city  and  entered  the  homes  of  some  of  their 
own  friends.  It  became  epidemic  in  the  wards, 
and  the  third  annual  report  of  the  State  Charities 
Aid  Association,  jMarch,  1875,  states  that  during 
this  time  two  out  of  every  five  infected  cases  died. 

The  managers,  naturally  enough,  were  unin- 
formed on  the  scientific  side  and  did  not  at  first 
possess  a  knowledge  of  the  relation  between  puer- 
peral sepsis  and  surgical  wards.  Sister  Helen, 
who  needed  all  her  discretion,  never  told  all  she 
knew,  but  drew  the  attention  of  the  managers  to 
the  forlorn  condition  of  the  maternity  wards, 
which  were  comfortless,  unsupervised,  and  quite 
lacking  in  good  moral  atmosphere,  and  further 
mentioned  that  she  heard  of  many  deaths  there. 

The  managers,  eager  to  help  the  unfortunate 
patients,  and  acting  on  Sister  Helen's  suggestion, 
that  with  a  few  more  nurses  added  to  the  staff  they 
might  be  enabled  to  care  for  the  maternity  ward, 
went  confidently  to  some  of  the  medical  authori- 
ties to  offer  to  undertake  this  extension  of  the  ser- 
vice, when,  to  their  amazement  and  chagrin,  they 
encountered  an  outburst  of  irritated  opposition. 
Their  oft'er  appeared  to  have  been  looked  upon 
as  a  criticism,  for,  incredible  as  it  seems,  they  were 
told  in  plain  words  that  their  meddling  in  the  hos- 
pital }nanagement  Jiad  gane  far  enough,  and,  as  nc 
more  of  tt  would  be  tolerated,  it  would  have  to  cease  A 

Astonished  and  indignant  they  returned  home, 
1  From  private  sources. 


A  Trio  of  Training  Schools       405 

but  not  to  give  up.  By  the  efforts  and  through 
the  mediation  of  Dr.  Wood,  the  matter  was  carried 
further,  and  a  time  and  place  appointed  for  its 
consideration  by  a  higher  body. 

At  this  meeting  the  ladies  did  not  appear  in  per- 
son, but  were  represented  by  their  husbands. 

It  was  agreed  that  the  nurses  should  be  placed 
in  the  maternity,  and  in  May,  1875,  the  change 
was  made,  the  first  attempt  at  negotiations  having 
been  made  earlier  in  the  year.  The  training  school 
report  of  that  year  says :  "  We  applied  in  Febru- 
ary to  the  Medical  Board  for  three  lying-in  wards 
at  Bellevue.  In  May  our  offer  was  accepted,  and 
the  nurses  entered  upon  the  new  field  of  service." 

But  still  the  patients  continued  to  die,  and  in 
deep  discouragement  and  perplexity  one  of  the 
managers  sat  one  day  in  the  library  of  a  medical 
friend,  and  expressed  the  disappointment  and  dis- 
tress which  she  felt  at  having  apparently  given  no 
better  service  than  the  untrained  helpers.  They 
felt,  she  said,  as  if  they  were  w^orking  in  the  dark. 
The  medical  friend  was  at  that  moment  hurriedly 
called  away,  but  as  he  departed  he  placed  an  open 
book  in  her  hand,  saying,  ''  Perhaps  this  will  help 
you."  It  was  the  treatise  before  referred  to,  writ- 
ten by  a  prominent  scientist,  whose  services  had 
been  given  to  the  city  poor,  and  to  her  amazement 
she  read  the  opening  words  enunciating  the  doc- 
trine of  the  fatal  relationship  between  surgical  and 
maternity  wards. 

This  was  the  light  that  she  had  felt  the  need  of, 


4o6  A  History  of  Nursing 

and  armed  with  this  declaration,  of  an  indisputa- 
ble eminence,  the  courageous  woman  returned 
single-handed  to  the  charge,  confronted  the  au- 
thorities, and  speedily  set  in  motion  the  forces  by 
which  the  maternity  wards  were  removed  from  the 
precincts  of  the  hospital.  ^  The  third  annual  re- 
port of  the  State  Charities  Aid  Association  says  on 
this  point :  "  It  was  through  the  representations  of 
our  Visiting  Committee  that  these  wards  were 
finally  closed,  and  the  remaining  twenty-five  wo- 
men, already  showing  symptoms  of  disease,  were 
removed  to  the  one-story  pavilion  on  BlackwelFs 
Island,  and  recovered."  Of  this  transfer  of  pa- 
tients Dr.  Carlisle  says  (after  discussing  the  epi- 
demic of  sepsis,  and  remarking  that  the  medical 
staff,  though  holding  that  improvements  were 
needed,  did  not  believe  that  the  wards  were  at 
fault),  "Nevertheless  the  opinion  of  those  least 
capable  of  judging  prevailed,  and  the  lying-in 
service  was  taken  from  Bellevue."  ^ 

I^Iiss  Linda  Richards,  who  was  then  at  Bellevue, 
WTites  of  those  events:  ''The  managers  had  been 
very  anxious  for  some  time  to  take  the  maternity 
wards,  but  the  doctors  said  they  preferred  their 
old  nurses  to  those  in  training,  and  so  they  had 
been  refused.  .  .  .  After  the  nurses  were  finally 
placed  in  charge  they  had  the  wards  for  twenty- 
seven  days  before  they  were  moved.  .  .  .  The 
patients  were  then  transferred  to  rough  buildings, 

»  From  private  sources. 
2  Op.  cit.,  p.  77. 


A  Trio  of  Training  Schools        407 

and,  strange  to  say,  there  was  no  more  fever  and 
only  two  deaths,  though  some  very  sick  patients 
had  been  transferred . ' ' 

Still  some  little  time  elapsed  before  the  women 
completed  the  regeneration  of  the  maternity  ser- 
vice. The  Island  quarters  were  very  satisfactory 
for  those  patients  who  could  get  there,  but  there 
was  no  provision  for  emergencies,  save  a  dreary 
room  at  the  ferryboat  landing,  where  what  was 
possible  had  been  done  for  emergency  patients 
to  ease  the  trial  by  having  a  nurse  in  attend- 
ance. This  was  a  voluntary  service  on  the  nurse's 
part.  Finally,  the  managers,  having  vainly  tried 
to  interest  a  wealthy  private  benevolent  society 
devoted  to  obstetrical  relief,  but  whose  funds 
could  be  employed  only  for  respectable  married 
women,  went  to  the  Grand  Jury,  and  secured  the 
use  of  the  old,  dismantled  engine-house  which  has 
since  that  day  been  familiar  to  all  the  generations 
of  Bellevue  nurses  as  ''The  Emergency."  The 
nurses  took  charge  of  it  on  June  13,  1877,  and  Dr. 
Wylie,  who  had  been,  as  usual,  a  strong  friend,  was 
soon  able  to  report  that  its  results  surpassed  those 
of  any  maternity  hospital  in  the  country. 

The  rescue  of  Bellevue  was  now  effected  in  all 
departments,  and  only  needed  to  be  perfected  in 
detail.  A  recent  publication  issued  by  the  man- 
agers contains  the  following : 

As  the  work  became  consolidated  in  the  hospital, 
its  influence  began  to  make  itself  felt  on  every  side. 


4o8  A  History  of  Nursing 

The  doctors  soon  discovered  that  operations  never 
before  attempted  were  possible,  in  consequence  of  the 
care  their  patients  received,  and  important  hygienic 
improvements  were  devised  and  carried  out  through 
the  united  influence  of  the  ladies'  committee  and  the 
Medical  Board  upon  the  Commissioners  of  Charities. 

In  1879  the  Sturges  Pavilion,  in  memory  of  the  late 
Jonathan  Sturges,  was  built  for  extreme  surgical  cases 
by  his  daughter,  Mrs.  AV.  H.  Osborn.  In  1882  the 
Marquand  Pavilion  for  women  and  children  was  built. 
In  1883  the  Townsend  Pavilion  was  erected  for  the 
special  treatment  of  women,  and  in  1888  a  pavilion 
was  built  by  Miss  Dehon  also  for  the  treatment  of 
women.  In  1891  Miss  Lazarus  built  a  pavilion  for 
the  special  accommodation  of  graduated  nurses  who 
were  ill  and  required  hospital  treatment,  and  a  fund 
for  its  support  was  given  by  Mrs.  Morris  K.  Jesup  in 
memory  of  her  sister,  Mrs.  Theodore  Cuyler,  who  was 
for  many  years  secretary  of  the  school.  Two  beauti- 
ful chapels  were  erected  for  the  Protestant  and  Cath- 
olic patients  by  Mrs.  Townsend  and  Miss  Leary.  It 
would  be  impossible  to  give  in  detail  an  account  of 
the  stream  of  benevolence  which  through  the  influence 
of  the  training  school  has  been  flowing  into  the  hos- 
pital during  the  past  twenty-five  j^ears,  and  which  has 
made  the  institution  a  benediction  to  the  poor  of  New 
York.  Xot  only  the  hospital,  but  the  whole  vicinity 
has  changed  its  character.  The  members  of  the  com- 
mittee were  assured  that  it  was  not  safe  for  ladies  to 
v^enture  into  that  part  of  the  city,  but  they  did  so  fear- 
lessly and  were  never  annoyed;  and  as  time  passed 
the  grog-shops  diminished,  the  disreputable  buildings 
disappeared,  and  now  the  neighbourhood  of  the  hos- 
pital is  filled  with  fine  buildings,  accommodating  the 


t/3   r; 

r-        6 

o    «  I 


<  a 


L.      in 

CI-    O 

o  a. 


I 


A  Trio  of  Training  Schools        409 

schools  and  other  institutions  which  form  branches 
of  the  hospital."^ 

The  general  and  liberal  intelligence  displayed 
by  the  group  of  men  and  women  who  conducted 
the  reforms  at  Bellevue  is  further  attested  by  other 
records  of  the  State  Charities  Aid  Association.  One 
refers  to  the  maternity  ward  question.  "  Our  Hos- 
pital Committee  [says  the  Third  Annual  Report], 
at  the  request  of  one  of  the  Commissioners  of  Char- 
ities, has  recently  been  engaged  in  the  preparation 
of  a  plan  for  new  maternity  wards.  But  the  pro- 
posed site  is  so  manifestly  unfit  that  we  would 
here  publicly  record  our  protest  against  it."  The 
site  proposed  by  the  hospital,  and  objected  to  by 
the  committee,  was  specified  as  being  too  close  to 
the  hospital,  and  just  north  of  the  morgue  and  the 
dissection  rooms.  It  was  ultimately  abandoned. 
The  other  refers  to  the  hospital  as  a  whole.  In 
1874  the  State  Charities  Aid  Association  presented 
a  report  recommending  the  rebuilding  of  Bellevue 
on  the  grounds  of  its  defective  ventilation,  bad 
construction,  and  the  existence  of  pyasmia.  The 
report  contained  exhaustive  statistics  and  was 
accompanied  by  a  strong  letter  from  Miss  Louisa 
Schuyler.  With  good  nursing  and  cleanliness 
pyaemia  soon  disappeared,  but  the  structural  dis- 
advantages of  the  hospital  have  been  acknow- 
ledged by  all  subsequent  critics,  and  the  building 
is  now  (1907)  on  the  eve  of  being  replaced  by  new 
structures. 

»  History  of  the  Establishment,  cit. 


410  A  History  of  Nursing 

In  the  summer  of  1876  the  school  lost  the  ser- 
vices  of  Sister  Helen,  who,  with  impaired  health 
and  other  obligations  before  her,  returned  to  Eng- 
land. She  had  placed  the  school  on  a  firm  basis, 
made  it  indispensable  to  the  hospital,  and  had  be- 
gun to  send  out  trained  women  to  extend  the  new 
system  and  teaching.  Her  pupils  were  ready  and 
able  to  teach  nursing,  but  none  of  them,  probably, 
would  have  been  able  to  cope  with  the  undercur- 
rents of  opposition  and  enmity  that  still  sought 
every  opportunity  of  undermining  the  authority 
of  the  superintendent  of  nurses,  as  Sister  Helen, 
from  her  great  experience,  was  able  to  do.  Only 
those  who  have  met  corrupt  political  influence  in 
hospitals  know  what  this  enmity  is.  Her  succes- 
sor, Miss  Eliza  Perkins,  though  not  a  nurse,  and  of 
a  character  unlike  Sister  Helen's,  nevertheless 
possessed  the  skill  and  ability  needed  for  the  posi- 
tion, and  she  was  selected  as  the  head  of  the  school. 
Sister  Helen  grounded  her  thoroughly  in  all  the 
principles  of  discipline,  order  of  seniority,  division 
of  authority  and  responsibility,  and  general  nurs- 
ing ethics,  as  well  as  the  etiquette  involved 
in  the  successful  administration  of  a  hospi- 
tal training  course;  and  admirably  did  Miss 
Perkins  apply  them  during  her  fifteen  years 
of  rule. 

Sister  Helen  sailed  for  England  leaving  behind 
her  the  following  letter  of  farewell  for  the  nurses 
for  whom  she  had  done  so  much  and  by  whom  she 
was  so  greatly  esteemed : 


A  Trio  of  Training  Schools        411 

THE  TRAINING  SCHOOL, 

314  East  26th  St.,  May  ist,  1876. 

To  THE  Members  of  the  Training  School. 

Dear  Friends  and  Fellow-Workers: — ^I  had  quite  in- 
tended to  have  a  little  talk  with  you  this  evening  and 
wish  you  all  good-bye,  but  I  am  stupidly  weak  and  may 
not  be  able  to  bear  it.  So  I  will  write  you  a  loving 
farewell  instead. 

May  God  bless  you  all,  and  prosper  you  in  your  work, 
and  give  you  the  grace  of  perseverance.  So  far  you 
have  done  nobly.  To-day  completes  our  first  three 
years.  I  look  back  on  the  past  with  great  thankful- 
ness for  what  has  been  achieved.  Three  years  ago  we 
commenced  what  was  by  many  thought  to  be  a  doubt- 
ful undertaking.  Now  the  training  school  is  a  flour- 
ishing institution,  standing  well  with  the  public  and 
valued  by  those  best  able  to  judge, — the  medical  staff 
at  Bellevue  and  the  employers  of  our  private  nurses. 
I  endeavoured  to  establish  the  work  on  a  right  founda- 
tion. The  ladies  of  the  committe  have  done  all  in 
their  power  to  advance  it.  But  all  this  would  have 
been  of  no  avail  but  for  the  earnest,  self-sacrificing 
work  of  the  nurses.     May  the  spirit  long  live. 

Now  I  feel  I  have  only  to  thank  those  most  who 
have  been  with  us  longest.  A  few  more  words  and 
I  am  done.  I  thank  you  lovingly  for  the  affectionate 
sympathy  you  have  shown  me  during  my  illness,  the 
way  you  have  done  your  duty  with  little  trouble  to 
Miss  Van  Rensselaer  and  have  let  me  alone.  Once 
more  good-bye  and  God  bless  you. 

I  hope  when  you  read  this  you  will  not  say, 
"Sister  speaks  as  if  we  were  never  to  see  her  again." 
Only   remember  parting    is   certain,  meeting  always 


412  A  History  of  Nursing 

doubt  fill,    especially    when    one  is  in  ill-health  and 
about  to  cross  the  Atlantic. 

Sister  Helen  of  All  Saints. ^ 

The  ^lassachusetts  General  Hospital  of  Boston 
was  the  last  of  the  trio  of  general  hospitals  to 
open  a  school  for  nurses.  The  "  History  of  the 
Boston  Training  School"  published  as  a  part  of 
the  annual  report  in  1904,  says: 

It  is  to  the  Woman's  Educational  Association  we 
owe  the  suggestion  of  a  need  in  Boston  of  a  training 
school  for  nurses.  The  matter  came  up  for  discussion 
at  a  meeting  held  in  April,  1873,  and  the  first  practi- 
cal steps  were  taken  toward  the  founding  of  a  system 
now  so  well  recognised  not  only  as  a  means  of  educa- 
tion for  women,  but  as  a  necessity  to  meet  the  de- 
mands of  the  community. 

The  Second  Annual  Report  of  the  Woman's 
Educational  Association  gives  more  fully  the  very 
first  steps: 

A  meeting  was  called  as  early  as  June,  1872,  to 
consider  the  subject,  and  it  was  made  a  special  object 
of  discussion  in  two  or  three  meetings  during  the  next 
autumn.  In  the  winter  of  1873  a  member  of  the  com- 
mittee heard  of  the  excellent  school  for  nurses  which 
had  been  established  in  New  York.  She  made  a  visit 
there,  and  satisfied  herself  that  the  plan  was  a  wise 
one  and  would  succeed.  The  report  induced  the  com- 
mittee to  believe  that  they  had  really  found  what  they 

1  Sister  Helen  later  gave  distinguished  service  in  the  colonial 
wars  of  England.  After  one  such  campaign  she  returned  to 
her  home  and  died  in  the  closing  years  of  the  century. 


A  Trio  of  Training  Schools        4^3 

had  been  so  long  seeking.  They  called  a  parlour  meet- 
ing in  order  to  consider  the  subject  more  fully  and  to 
interest  persons  outside  of  the  association  in  the  plan. 
This  meeting  brought  out  the  expression  of  so  much 
interest  and  so  much  sympathy  with  the  movement 
that,  though  the  difficulties  of  the  undertaking  were 
seen  to  be  great,  the  committee  reported  in  favour  of 
it  at  the  regular  meeting  of  April  lo,  and  recommended 
that  it  should  be  committed  to  the  charge  of  twelve 
ladies  and  gentlemen,  who  should  organise  it  and  carry 
it  on  independently  of  this  association.  In  conse- 
quence of  this  action  a  circular  was  sent  out  summon- 
ing a  meeting  of  all  those  who  were  interested  either 
for  or  against  the  training  of  nurses. 

The  meeting  was  held  in  May,  1873,  and  was  large 
and  representative.  There  were  those  who,  without 
knowing  how  such  a  revolution  was  to  be  brought 
about,  were  eager  for  the  day  when  this  new  order  of 
being,  a  trained  nurse,  was  to  be  had  for  the  asking 
and  pay;  for  it  must  be  remembered  that  it  was  not 
only  the  quality,  but  the  quantity,  that  was  lacking, 
and,  literally  speaking,  the  whole  of  a  long  day  some- 
times had  to  be  spent  in  looking  for  a  reliable  nurse. 
There  were  not  many  physicians  present :  a  few  came 
to  watch  proceedings,  some  to  speak — not  unfriendly 
words,  though  rather  anxious  ones.  Dr.  Susan  Dim- 
ock  gave  encouragement  with  most  delightful  voice 
and  manner.  The  upshot  of  it  all  was  that  a  commit- 
tee was  formed,  and  then  the  work  began  .  .  .  first 
to  decide  upon  a  plan,  to  ask  for  the  co-operation  of 
physicians,  and  to  raise  money.  ...  A  letter  was  sent 
to  the  trustees  of  the  Massachusetts  General  hospital 
asking  their  permission  to  establish  the  training  school 
in  connection  with  that  hospital.     The  answer  seeming 


414  A  History  of  Nursing 

favourable  to  the  plan,  a  conference  was  arranged.* 

The  trustees  responded  with,  on  the  whole,  grat- 
ifying readiness,  though  they  held  off  a  little  warily 
from  the  possibility  of  interference  with  their  au- 
thority. They  proposed  placing  two  wards  in  the 
care  of  the  training  school  committee,  but  under 
the  following  conditions :  that  the  relation  between 
hospital  and  school  should  continue  during  the 
pleasure  of  the  trustees;  that  the  school  should 
take  on  as  pupils  such  nurses  then  employed  in  the 
wards  as  the  trustees  wished  to  retain ;  that  the 
nurses  and  pupils  of  the  school  should  not  attend 
the  patients  of  the  hospital  without  previous  in- 
struction in  moving  and  caring  for  bed-patients; 
that  nurses  should  agree  to  remain  for  at  least  two 
years,  but  that  the  trustees  reserved  the  right  to 
discharge  them  from  service  in  the  wards  for  suffi- 
cient cause ;  that  the  superintendent,  nurses,  pupils, 
and  all  persons  employed  by  the  school  should  be 
under  the  medical  jurisdiction  of  the  physicians 
and  surgeons  (and,  of  course,  subject  to  the  rules 
of  the  trustees),  and  that  **no  instruction  of  or 
interference  with  said  persons  within  the  hospital 
shall  be  permitted  without  consent  of  such  physi- 
cians and  surgeons";  that  wages  should  be  paid 
by  the  hospital  and  not  by  the  school,  and  that  the 
duties  of  the  superintendent  should  not  conflict 
with  those  of  the  matron. 

1  '*  Early  History  of  the  Boston  Training  School,"  by  Mrs. 
Curtis  and  Miss  Denny,  members  of  the  original  board.  The 
Amer.  Journ.  of  Nursing,  February,  1902,  p.  332. 


A  Trio  of  Training  Schools        415 

The  training  school  committee,  finding  these 
regulations  leaned  a  little  too  far  in  favour  of  the 
trustees,  offered  to  accept  the  responsibility  for 
the  wards  and  the  nursing  provided  the  trustees 
were  willing  to  modify  some  of  their  conditions — 
among  others,  that  the  school  also  have  the  right 
to  terminate  the  connection  with  the  hospital,  not 
less  than  two  months'  notice  being  required  in 
either  case;  that  the  director  of  the  school  also 
should  have  the  right  to  discharge  any  nurse  or 
pupil,  and  that  the  word  ''interference"  should 
not  be  held  to  apply  to  the  rules  and  discipline 
which  (subject  to  the  regulations  of  the  hospital) 
the  directors  might  judge  necessary  for  the  good 
government  of  the  school,  nor  any  visits  of  direc- 
tors made  to  inform  themselves  of  the  condition 
of  the  school. 

These  modifications  were  evidently  agreed  to 
by  the  trustees,  for  the  training  school  committee 
now  set  to  work  in  earnest,  raised  the  money, 
rented  a  house  for  the  nurses,  and  undertook  to 
be  ready  by  the  ist  of  November  to  take  charge 
of  the  wards.  Short  as  was  the  time  allowed, 
the  committee  met  its  obligations  to  the  day,  and 
with  a  superintendent,  two  head  nurses,  and  four 
pupils,  took  charge  of  its  two  wards  on  the  ist 
of  November. 

The  hospital,  in  its  interior,  and  its  former  nurs- 
ing service,  was  very  different  from  Bellevue.  The 
Massachusetts  General  stood  with  such  institutions 
as  the  New  York  and  Pennsylvania  hospitals,  and 


41 6  A  History  of  Nursing 

all  of  its  arrangements  were  equal  to  the  best 
known  at  that  time.  It  was  clean,  bright,  pleas- 
ant, and  the  comfort  of  the  patients  was  consid- 
ered in  everv'  way.  It  was  already  historically 
important  as  the  scene  of  the  first  major  operation 
performed  under  the  influence  of  ether,  for  it  was 
there  that  Morton  had  demonstrated,  on  October 
1 6,  1846,  the  discovery  of  aucesthesia,  having  pre- 
viously experimented  upon  himself.  The  ^lassa- 
chusetts  General  was  noted  for  the  dignity  and 
refinement  of  its  operation-room  work,  and  for 
white  linen  coverings  of  especial  purity  and  fine- 
ness. The  women  who  had  worked  there  as  nurses 
were  of  a  highly  estimable  type,  good,  conscien- 
tious, and  faithful.  An  account  of  the  early  days 
in  the  hospital  by  one  of  its  matrons  makes  this 
fact  very  clear,  even  if  there  were  not  other 
testimony.  ^ 

The  conditions  were  not  very  comfortable  for 
the  nurses.  ^liss  Sturtevant  had  entered  the  hos- 
pital as  assistant  nurse  at  seven  and  a  half  dollars 
a  week  in  1862.  The  nurses  slept  in  little  rooms 
between  the  wards,  two  in  one  bed,  which  was 
folded  out  of  the  way  by  day,  for  the  room  then 
became  a  passage,  or  consulting-room,  or  even  a 
place  for  dressings  and  minor  operations.  The 
hours  on  duty  were  from  five  in  the  morning  to 
half-past  nine  in  the  evening,  with  an  occasional 

1  "  Personal  Recollections  of  Hospital  Life  before  the  Days 
of  Training  Schools,"  by  G.  L.  Sturtevant.  The  Trained 
Nurse,  December,  1895,  pp.  287-291. 


A  Trio  of  Training  Schools        4^7 

hour  off.  The  nurses  had  a  dark  and  dingy  dining- 
room,  with  pewter  tumblers  and  other  fittings  to 
match.  There  was  no  lucrative  private  duty  to 
look  to,  as  nursing  was  considered  to  be  an  occupa- 
tion only  suitable  for  elderly  females.  Neverthe- 
less, many  excellent  women  served  conscientiously 
in  the  hospital  for  years  at  a  time.  There  were 
eleven  head  nurses  and  about  sixteen  assistants, 
besides  "  night  watchers."  The  way  the  work  was 
arranged  was  very  crude  and  was,  indeed,  inher- 
ited from  earlier  centuries.  For  instance,  all 
soiled  linen  was  first  washed  by  the  nurses  in  the 
ward  bath-rooms  before  being  sent  to  the  laundry. 
Miss  Richards  has  described  the  curious  rotation 
of  service — how  each  nurse  had  a  round  of  duty 
from  ward-work  and  the  care  of  patients  to  a  turn 
at  the  washtubs,  and  how  tenaciously  this  custom 
was  clung  to.  Nothing,  however,  could  better 
illustrate  the  different  character  of  the  old  nursing 
system  and  the  new  than  the  story  which  is 
related  by  this  same  veteran  pioneer : 

In  one  of  the  large  hospitals  where  I  was  organis- 
ing a  training  school  n  those  early  days,  before  I  had 
really  taken  hold  of  the  work,  but  was  finding  my 
bearings  before  making  changes,  I  was  making  rounds 
one  morning  when,  upon  entering  a  ward,  I  saw  at  a 
glance  that  a  man  in  a  bed  near  the  door  was  dying. 
The  nurse  stood  near,  in  full  view  of  the  man's  face, 
quietly  doing  her  morning  dusting,  and  doing  it  well. 

I  stepped  to  the  bedside,  examined  the  patient's 
pulse,  wiped  the  dampness  from  his  face,  and  then, 


41 8  A  History  of  Nursing 

going  back  to  the  nurse,  who  was  still  dusting,  I  in- 
quired, "How  long  has  this  man  been  in  this  condi- 
tion?" She  looked  up  with  a  very  blank  expression  on 
her  face  and  asked,  "What  condition?"  I  said,  "Do 
you  not  know  that  the  man  is  dying  ? "  She  answered 
with  surprise,  "Why,  no."  I  instructed  her  to  send  for 
the  doctor  at  once,  place  screens  around  the  bed,  and 
to  stay  with  the  patient  as  long  as  he  lived,  and 
passed  on.  Later  in  the  day,  when  I  made  rounds 
again,  the  nurse  came  to  me  and  said,  "  Miss  Richards, 
would  you  mind  telling  me  how  you  knew  that  man 
was  dying?"  I  asked  her  how  long  she  had  been  in 
that  ward,  and  she  replied  two  years.  Then  I  said  to 
her:  "You  have  been  in  this  ward  all  that  time,  with 
patients  coming  and  going  and  with  some  dying:  will 
you  tell  me  how  you  can  have  been  here  so  long  and 
not  know  when  a  man  is  dying?  I  will  tell  you  how  I 
know:  by  caring  for  my  patients,  by  carefully  watch- 
ing them  and  observing  the  changes  from  day  to  day 
and  from  hour  to  hour,  by  being  interested  in  each 
one  as  a  human  being  entrusted  to  my  care. "  This 
will  give  some  idea  of  the  quality  of  the  nursing  before 
training  schools  were  organised.^ 

The  first  superintendent  of  nurses  was  Mrs.  Bill- 
ings, who  had  had  experience  as  a  hospital  nurse 
during  the  Civil  War.  Sister  Helen  of  Bellevue 
was  appealed  to  to  give  Mrs.  Billings  some  insight 
into  training  school  management,  and  with  some 
reluctance,  based  on  the  shortness  of  the  time 
allowed  her,  consented  to  give  her  two  months' 

»  "  Thirty  Years  of  Progress,"  by  Linda  Richards.  Ameri- 
can Journal  of  Nursing,  January,  1904,  pp.  263-267. 


A  Trio  of  Training  Schools       419 

experience.  Mrs.  Billings,  however,  only  held 
her  position  a  few  months,  and  was  succeeded  by 
Mrs.  Mary  von  Olnhausen,  a  woman  of  highly  orig- 
inal and  picturesque  characteristics,  w^ho  had 
served  as  a  sort  of  free  lance  through  our  own  civil 
and  the  Franco- Prussian  wars,  and  who  has  left 
an  entertaining  account  of  her  dramatic  career.  ^ 

Though  Mrs.  von  Olnhausen  proved  to  be  too  im- 
puls've  and  individualistic  to  be  a  successful  head, 
not  having  had  the  kind  of  training  necessary  for 
the  enforcement  of  discipline,  the  training  school 
committee  did  not  lose  courage,  although  the  suc- 
cess of  their  experiment  hung  for  a  time  wavering 
in  the  balance. 

The  medical  staff  from  the  beginning  had  not 
wanted  the  school.  They  preferred  their  old- 
fashioned  nursing  system  and  the  old  untrained 
nurses,  and  when  the  wards  under  the  new  ar- 
rangement did  not  run  smoothly  the  school  was 
considered  to  be  the  whole  cause  of  trouble.  Fi- 
nally the  trustees  told  the  training  school  com- 
mittee that  if  they  could  place  a  graduate  nurse 
in  charge  the  school  would  be  given  another  year's 
trial,  but  if,  at  the  end  of  that  time,  it  had  not  yet 
been  proved  to  be  of  real  value  to  the  hospital,  it 
would  be  given  up.  At  ths  critical  juncture  Miss 
Linda  Richards  was  put  in  charge,  and  from  her 
advent  date  the  real  progress  and  success  of  the 

» Adventures  of  an  Army  Nurse,  by  Mary  von  Olnhausen, 
edited  by  James  Phinney  Munroe.  Little,  Brown  &  Co., 
Boston,  1903. 


420  A  History  of  Nursing 

new  system.     Her  own  recollections  of  that  time 
are  full  of  interest .     She  says : 

On  the  one  hand  the  committee,  a  body  of  brave  men 
and  women,  fought  for  the  school,  and  on  the  other 
the  physicians,  with  two  exceptions,  were  against  it. 
Between  the  two  stood  the  trustees.  I  fully  realised 
that,  if  I  failed  to  prove  that  educated  and  trained 
nurses  were  superior  to  uneducated,  untrained  ones  a 
death-blow  would  be  given  to  the  school  in  that  hos- 
pital and  serious  injury  would  be  sustained  by  the 
movement  generally. 

In  order  to  make  a  record  for  the  cause  Miss 
Richards  took  charge  of  all  special  night  duty  and 
gave  her  personal  attention  to  all  serious  cases,  in 
addition  to  carrying  out  her  general  duties  of  su- 
pervision and  teaching  as  superintendent.  She 
writes : 

I  was  blessed  with  an  extraordinary  amount  of 
strength,  could  endure  hardship  well,  and  possessed 
a  hopeful  disposition,  so  I  was  able  to  do  plenty  of 
work  of  a  sufficiently  good  quality  to  prove  the  supe- 
riority of  the  new  over  the  old.  My  first  happy  day 
there  was  at  the  end  of  three  months,  when  the  super- 
intendent of  the  hospital  told  me  that  the  trustees 
had  voted  to  give  the  school  another  ward,  and  added : 
"The  school  is  safe.  Before  another  year  comes  round 
vou  will  have  the  nursing  of  the  entire  hospital  in 
charge."  It  so  proved,  and  gradually  the  medical 
staff  came  to  feel  that  trained  nurses  were  valuable; 
one  by  one  they  became  firm  friends  of  the  school,  and 
at  the  end  of  my  first  year  the  trustees  adopted  the 


A  Trio  of  Training  Schools        421 

school  as  a  part  of  the  hospital,  with  a  committee  of 
its  own.  We  had  a  small  but  comfortable  home,  and 
felt  that  we  stood  upon  firm  ground. 

Miss  Richards  stayed  there  two  and  a  half  years, 
and  then  went  to  England  to  study  training  school 
methods  there.     She  continues : 

For  the  last  year  and  a  half  the  wheels  ran  very 
smoothly  indeed.  I  have  never  worked  with  a  more 
loyal,  helpful  committee,  and  but  for  their  help  and 
support  those  first  months  would  have  been  very  hard 
to  live  through.  They  were  not  happy  at  their  best. 
I  seldom  look  back  upon  them.  I  seemed  to  meet 
hostility  on  all  sides.  We  were  living  down  a  strong 
prejudice.  We  suffered,  but  we  conquered,  and  I  am 
glad  that  I  fought  that  fight." 

From  here,  having  placed  the  school  on  a  firm 
foundation,  Miss  Richards  went  to  St.  Thomas's 
hospital,  England,  where  she  was  permitted  to 
spend  eight  weeks  in  visiting  wards,  assisting  with 
work  or  not,  as  she  chose,  and  witnessing  opera- 
tions. Her  experiences  there  were  very  interest- 
ing. She  met  many  of  the  women  who  were 
notable  in  nursing  work,  and  tells  the  following 
little  anecdote  of  Miss  Nightingale : 

I  had  been  in  the  **home"  less  than  a  week  when 
an  invitation  came  from  Miss  Nightingale  for  me  to 
visit  her  in  her  London  home.  Shall  I  ever  forget  the 
excitement  that  invitation  caused?  Miss  Crossland 
told  me  Miss  Nightingale  would  ask  my  opinion  of  the 
different  nurses,  both  ladies  and  others,  and  I  could 
see  that  there  was  a  little  anxiety  felt  concerning 
the  answers  I  might  give.     I  went  on  the  appointed 


422  A  History  of  Nursing 

day  and  must  say  I  did  not  feel  quite  at  my  ease  as 
the  maid  took  me  to  Miss  Nightingale's  room,  but  one 
look  into  those  kind,  clear-blue  eyes  and  the  hearty 
grasp  of  the  little  hand  quite  set  me  at  ease,  and  before 
I  knew  it  I  was  talking  as  freely  to  her,  who  had  done 
more  than  any  woman  living  to  alleviate  suffering, 
as  I  would  have  to  a  life-long  friend.  Miss  Nightin- 
gale was  lying  upon  the  bed  (I  have  never  seen  her  in 
any  other  position,  though  I  afterwards  had  the  very 
great  pleasure  and  honour  of  visiting  her  a  few  days 
in  her  beautiful  country  home).  She  was  dressed  in 
black  and  on  her  head  she  wore  a  very  becoming  cap. 
.  .  .  Miss  Nightingale  said,  "I  am  very  glad  to  see 
you  and  talk  of  the  training  school  work  in  America." 
She  asked  me  much  in  detail,  and  carefully  wrote  all 
down.  When  I  returned  to  the  hospital  the  questions 
w^ere  numerous:  "What  did  Miss  Nightingale  say?" 
"What  did  she  want  to  know?"  But  had  she  asked 
me  for  criticism,  which  she  did  not,  I  could  have  found 
none,  and  as  I  look  back  to-day  I  can  think  of  none.  .  . 
I  w^ent  from  Edinburgh  for  a  few  days  with  Miss 
Nightingale  and  received  from  her  words  of  encourage- 
ment which  have  lasted  all  these  years.  In  one  of 
her  letters  to  me  just  as  I  was  leaving  England  she 
bade  me  and  our  profession  Godspeed,  saying,  "Out- 
strip us,  that  we  in  turn  may  outstrip  you  again.  "^ 

Miss  Linda  Richards  has  had  a  rarely  extensive 
and  useful  career  as  a  nurse.     On  her  return  from 
England  in  1878  she  organised  the  training  school  J 
of  the  Boston  City  hospital.     In  1885  she  was  sent 
by  the  American  Board  of  Missions  to  Tokio,  Ja- 

»"  Recollections  of  a  Pioneer  Nurse,"  by  Linda  Richaris. 
American  Journal  of  Xursi}ig,  January,  1903,  pp.  248,  252. 


A  Trio  of  Training  Schools        423 

pan,  where  she  organised  a  school  to  train  Japan- 
ese nurses.  On  her  return  she  organised  the  school 
of  the  Methodist  hospital,  Philadelphia,  and  in 
1893  was  called  to  her  alma  mater  as  superintend- 
ent. Miss  Richards  has  been  continually  called 
from  one  hospital  to  another,  either  to  organise  a 
new  school,  or  to  build  up  one  that  was  undevel- 
oped. In  this  way  she  has  given  service  at  the 
Homeopathic  hospital  of  Brooklyn,  the  Hartford 
hospital,  the  University  hospital,  Philadelphia, 
and  then  began  a  series  of  regenerative  services  in 
hospitals  for  the  insane,  beginning  with  that  at 
Taunton,  Massachusetts.  Her  success  in  creating 
a  new  ideal  and  developing  improved  systems  of 
nursing  in  these  hospitals  has  been  so  distinguished 
that  here  too  she  has  been  called  from  one  post  to 
another  to  organise  and  teach. 

The  Connecticut  Training  School,  opened  in 
New  Haven,  was  second  of  the  distinguished  trio, 
though  it  had  obtained  its  charter  before  the  Belle- 
vue  school  had  one.  A  notable  feature  in  the  in- 
ception of  this  school  is  the  prominent  part  taken 
by  men  in  bringing  about  the  new  style  of  nursing, 
though  in  New  Haven,  too,  as  well  as  in  other 
places,  the  activity  of  the  women  during  the  Civil 
War  had  permeated  all  society  with  new  standards. 
The  management  of  the  hospitals  throughout  Con- 
necticut was  largely  in  the  hands  of  the  General 
Hospital  Society  of  Connecticut,  a  dignified  and 
weighty  body  that,  in  1876,  celebrated  its  semi- 
centennial.     This    society    first    considered    the 


424  A  History  of  Nursing 

subject  of  training.  Its  own  records  are  very  brief,  ^ 
but  we  shall  quote  ^Irs.  Francis  Bacon's  history 
of  the  foundation  of  the  Connecticut  Training 
School, 2  omitting  only  her  preamble. 

The  great  need  for  nurses  seems  to  have  impressed 
the  gentlemen  of  the  Hospital  Society  as  early  as  1872, 
a  year  before  we  had  thought  of  the  matter,  and  at 
their  annual  meeting,  May  the  9th  of  that  year,  they 
discussed  the  subject  and  appointed  a  committee, 
"consisting  of  Drs.  White,  Jewett,  and  Daggett,  to 
inquire  and  report  on  the  practicability  of  making 
the  hospital  available  as  a  training  school  for  nurses." 

Before  the  committee  had  time  to  report  to  the 
Hospital  Society  in  the  spring  of  1873,  Mr.  Charles 
Thompson,  of  this  city,  who  in  his  own  family  had 
suffered  from  the  ignorance  of  the  old-fashioned  nurse, 
and  who  was  familiar  with  the  European  system  of 
training  schools,  called  upon  Dr.  Francis  Bacon,  ac- 
companied by  his  and  our  friend  Dr.  William  L. 
Bradley,  for  the  purpose  of  consulting  him  as  to  the 
desirableness  of  attempting  to  establish  a  school  for 
nurses  in  Xew  Haven. 

So  that  from  two  different  directions  simultaneously 
a  movement  was  being  made  which  resulted  in  the 
founding  of  this  school. 

Mr.  Thompson's  interest  was  gratefully  appreciated, 
and  the  result  of  his  conversation  with  Drs.  Bradley 
and  Bacon  was  that  he  was  asked  to  draw  up  a  plan 

1  See  The  Semi-Centennial  History  of  the  General  Hospital 
Society  of  Connecticut,  by  P.  A.  Jewett,  M.D.  Xew  Haven, 
1876. 

2  Read  at  the  graduating  exercises,  1895.  Reprinted  in  The 
Trained  Nurse,  October,  1895,  PP-  187-193. 


A  Trio  of  Training  Schools        425 

embodying  his  ideas  as  to  the  training  of  nurses, 
and  this  plan  was  submitted  to  the  committee  above 
mentioned;  and  following  this,  at  the  next  meeting 
of  the  General  Hospital  Society,  this  paper  was  read, 
which  Dr.  Bishop  has  kindly  copied  from  the  proceed- 
ings of  the  society,  April  17,  1873 : 

"The  committee  to  whom  was  referred  the  subject 
of  a  training  school  for  nurses  would  respectfully 
report : 

"ist.  That  in  their  opinion  it  is  not  expedient  for 
the  Hospital  Society  to  undertake  the  direct  organisa- 
tion and  management  of  a  training  school  for  nurses. 

"2nd.  They  are  highly  gratified  to  learn  that  ar- 
rangements are  in  progress  for  the  organisation  of  a 
training  school  for  nurses  by  a  society  devoted  to 
that  special  object.  They,  therefore,  recommend  the 
adoption  of  the  following  resolutions: 

"  Resolved,  That  this  society  feels  deeply  im- 
pressed with  the  importance  of  encouraging  in  every 
suitable  manner  the  special  education  and  training  of 
nurses  for  service  in  hospitals  and  in  private  families, 
and  for  attendance  upon  the  sick  poor ;  therefore, 

"  Resolved,  That  if  a  society  is  organised  for  the 
training  of  nurses,  the  directors  of  the  General  Hos- 
pital Society  of  Connecticut  are  hereby  authorised 
and  advised,  under  suitable  regulations,  to  afford  to 
said  society  such  facilities  for  the  instruction  of  nurses 
as  can  be  given  at  the  hospital,  consistent  with  the 
proper  management  of  and  general  interests  of  the 
hospital. 

"  (Signed), 

"  M.  C.  White,      ) 
D.  L.  Daggett,  >■  Committee. " 
P.  A.  Jewett,     ) 


426  A  History  of  Nursing 

It  was  a  very  fortunate  coincidence  that  just  at  the 
moment  when  the  Hospital  Society,  after  a  year's  con- 
sideration, had  decided  against  organising  or  manag- 
ing a  training  school,  we,  without  collusion,  should 
have  offered  to  do  this  work  for  the  institution. 

This  report  of  the  hospital  committee  to  the  Hos- 
pital Society  is  the  first  definite  and  official  action 
taken  upon  the  subject  of  training  nurses  in  Xew  Ha- 
ven. It  is  the  little  seed  from  which  we  have  in 
twenty-one  years  branched  out  into  full  usefulness. 

Acting  upon  the  encouragement  thus  received,  and 
inspired  by  Mr.  Thompson,  thirty  or  forty  ladies  and 
gentlemen  associated  themselves  for  the  organisation 
of  the  Connecticut  Training  School.  A  pamphlet 
explaining  the  plan  and  setting  forth  its  advantages 
was  printed  at  Mr.  Thompson's  expense,  and  the  co- 
operation of  all  good  citizens  was  asked,  packages  of 
the  pamphlets  and  circulars  were  mailed  to  every 
prominent  physician  and  clergyman  in  the  State,  and 
many  cordial  endorsements  were  received. 

.  .  .  After  a  careful  study  of  the  English  hospital 
school  methods,  a  plan  was  drawn  up  for  the  organ- 
isation of  this  school  and  for  its  connection  with  the 
hospital,  a  series  of  resolutions  were  proposed  for  the 
consideration  of  the  directors  of  the  hospital,  and,  armed 
with  all  this,  Dr.  Bacon  presented  to  the  directors  at 
their  next  meeting  the  proposal  that  the  new  organisa- 
tion should  assume  the  charge  of  the  niirsing  at  this 
hospital.  .  .  . 

These  resolutions  are  the  ones  which,  printed  and 
framed,  hung  for  years  in  the  hospital  office,  and  they 
give  our  status  with  regard  to  the  hospital,  define  our 
relations  with  each  other,  and  they  have  been  exten- 
sively borrowed  by  other  training  schools. 


A  Trio  of  Training  Schools        427 

Here  we  were  then,  fairly  launched,  but  without  a 
penny  of  money  or  a  single  pupil,  and  now  the  hard 
work,  which  for  twenty-one  years  the  school  commit- 
tee has  carried  on,  commenced.  The  ladies  at  once 
set  themselves  to  the  work  of  finding  pupils  and  secur- 
ing a  superintendent.  Circulars  in  large  type  and 
bright  colours  were  distributed  at  the  railroad  stations 
and  mailed  to  rural  post-offices,  with  the  request  that 
the  postmaster  would  pin  them  up  in  some  conspic- 
uous place. 

Ladies'  missionary  associations  in  eighteen  towns 
were  asked  to  make  the  plan  known  and  to  put  up,  in 
places  where  they  would  attract  attention,  the  adver- 
tising circulars.  Articles  were  written  to  all  the  lead- 
ing newspapers  of  the  State,  and  were  extensively 
copied  in  the  smaller  rural  journals.  Nearly  all  the 
applications  came  from  young  women  who  had  read 
in  obscure  villages  the  articles  copied  from  papers  in 
larger  towns. 

While  all  efforts  were  being  made  to  interest  young 
women  and  secure  pupils,  Mr.  Thompson  devoted 
himself  to  raising  money,  and  but  for  his  generosity 
we  could  not  have  begun  the  school.     In  September, 

1873,  he  authorised  us  to  draw  upon  him  for  $i,ooo^ 
and  under  certain  conditions  for  $2,500.     In  March, 

1874,  through  the  kindness  of  Dr.  Moses  C.  White, 
Mrs.  Gill,  of  West  Haven,  left  us  a  tract  of  land 
which  will  later  become  valuable,  and  through  Mr. 
Thompson's  further  efforts  $10,000  to  $12,000  were 
contributed  by  many  generous  friends  as  an 
endowment. 

May  21,  1873,  the  full  school  committee  held  itf 
first  formal  meeting  for  the  appointment  of  a  superin 
tendent  of  nursing.     Many  hospitals  had  been  visited 


428  A  History  of  Nursing 

and  inquiries  made,  and  at  last  the  only  training 
school  in  existence  in  this  country  [this  statement 
overlooks  the  Xew  England  hospital  for  Women  and 
Children],  the  Woman's  hospital  of  Philadelphia, 
referred  to  above,  sent  us  our  first  superintendent. 
Answers  began  to  come  in  from  applicants  for  admis- 
sion, and  out  of  twenty-one,  six,  the  number  to  which 
the  hospital  limited  us  at  first,  were  finally  selected. 
Two  of  these  failed,  through  sickness,  at  the  last  mo- 
ment, and  on  October  6,  1873,  our  first  four  pupils 
arrived  late  in  the  evening,  and  in  a  dreary  storm. 
The  new  wards  to  the  south  were  not  free  from  the 
workmen,  but  small  sleeping  rooms  were  assigned  to  us 
on  the  top  floor,  and  comfortably  furnished.  The 
diet  kitchen,  in  the  basement,  had  been  fitted  up  at 
the  expense  of  the  training  school,  floor  laid,  stove 
and  kitchen  utensils  supplied,  and  our  four  nurses 
and  their  superintendent  found  themselves  at  once 
plunged  into  hard  work.  The  north  ward  was  full  of 
typhoid  fever,  ten  cases,  six  men  and  four  women,  and 
wards  i  and  2,  E  and  W.,  were  opened  and  filled  dur- 
ing the  first  week.  The  committee's  journal  reads; 
"  Our  niirses  for  the  first  five  weeks  did  very  hard  work. 
The  fever  cases  were  severe,  some  of  the  patients  en- 
tirely delirious,  throwing  themselves  out  of  bed,  or 
getting  up  and  dragging  their  sheets  and  blankets  out 
into  the  entry,  if  the  nurses  had  to  cross  from  the 
men's  to  the  women's  ward.  The  four  nurses  in  turn 
sat  up  night  after  night  and  did  duty  during  the  day 
in  the  other  wards,  or  diet  kitchen,  where  the  special 
diet  for  thirty  was  cooked  and  distributed  to  all  parts 
of  the  hospital  by  the  nurses  who  cooked  it.''  The  jour- 
nal adds:  *'A11  the  men  nurses,  on  the  arrival  of  the 
yoimg  women,  at  once  set  themselves  to  take  their 


A  Trio  of  Training  Schools        429 

2ase  and  to  shirk  all  concern  with  distributing  the 
diet  or  returning  the  dishes." 

The  school  at  last  engaged  and  paid  three  women 
from  the  city  to  help  in  the  stress  of  work.  On  the 
ist  of  October,  1873,  there  were  seventy- two  patients 
in  the  hospital,  but  by  December  31  the  average  for 
the  quarter  had  risen  to  no.  Not  until  a  year  later 
had  we  permission  to  raise  the  number  of  pupils  to 
eight,  and  it  was  May,  1875,  before  we  were  allowed 
nine  in  consequence  of  the  night  service. 

Hard  as  the  work  has  often  been  in  later  years,  no 
class  of  nurses  ever  had  such  demands  made  upon  its 
endurance  as  this  pioneer  class  of  pupils  met  and  strug- 
gled through.  All  the  typhoid  fever  cases  recovered, 
and  it  was  a  proud  moment  for  the  school  when 
the  value  of  the  work  done  was  fully  appreciated  and 
acknowledged  by  Dr.  Moses  C.  White,  the  attending 
physician.  "I  have  never  before,"  he  said,  "had  a 
case  of  fever  in  the  hospital  without  a  black  crust 
tongue,"  no  appearance  of  which  had  he  found  since 
our  nurses  took  hold.  Through  Dr.  White's  efforts 
little  improvements  were  added,  and  at  the  request  of 
our  superintendent  he  secured  additional  closets  in 
the  north  ward  entries.  Our  nurses,  who  have  more 
closets  than  they  know  what  to  do  with,  may  think 
what  such  a  statement  as  this  in  the  committee's 
journal  implied:  "The  new  closets  being  put  up,  the 
miscellaneous  packing  of  slices  of  bread,  old  clothes, 
bedding,  oil  lamps,  rags,  etc.  (which  had  always  been 
stowed  in  the  same  closet)  was  put  an  end  to."  I 
mention  these  little  details  that  our  nurses  may  more 
fully  appreciate  the  comfort  which  has  surrounded 
them,  in  contrast  to  the  difficulties  faced  by  the  first 
brave  four.     Everything,  as  I  have  said,  was  in  a 


430  A  History  of  Nursing 

transition  state.  The  nurses  were  crowded,  as  their 
numbers  increased,  into  the  three  small  rooms  in 
the  top  floor  of  the  new  building — four  in  a  room — and 
the  clothes-horse  screens  which  divided  their  beds  one 
from  another  were  the  first  screens  of  the  kind  used 
in  the  hospital. 

The  first  superintendent  of  nursing  was  asked  to 
take  her  dinner  at  the  table  with  fourteen  men  pa- 
tients in  the  basement,  and  later  the  pupils'  meals 
were  served  in  their  own  diet  kitchen,  and  very  poor 
ones  they  were,  too.  .   .   . 

The  ladies'  committee,  too,  was  new  to  the  business 
before  it  and  learned  by  experience  the  needs  of  the 
school.  One  of  the  first  things  to  do  was  to  abate  the 
trailing  skirts  and  jewelry  of  the  newly  arrived  pupils, 
whose  ideas  were  crude  as  to  the  proper  dress  for  a 
trained  nurse.  I  remember  one  morning  I  was  met 
by    the    head  nurse  with    the    despairing    question: 

*'What  shall  I  do  with  Miss  ?     She  appeared 

at  breakfast  with  all  her  long  hair  curled  down  her 
back."  Caps  were  immediately  introduced,  and  no 
one  needs  now  to  be  told  that  bushy  hair  is  out  of 
place  in  a  sick-room.  All  the  irregularities  were 
slowly  corrected;  comfort  came  out  of  confusion. 
The  surgeons,  assured  of  good  nursing,  undertook 
operations  never  before  attempted  in  a  hospital. 
And  on  March  26,  six  months  after  we  began,  the 
Hospital  Society,  which  had  ordered  an  inquiry  made 
as  to  our  work,  directed  the  secretary.  Dr.  C.  A.  Linds- 
ley,  to  inform  us  in  writing  as  follows:  "In  regard 
to  the  work  undertaken  by  the  school  in  the  care  of 
the  sick  and  disabled,  we  find  for  it  many  general 
commendations.  The  physicians  and  surgeons  report 
a  decided  improvement  in  the  nursing,   and  speak 


A  Trio  of  Training  Schools        431 

strongly  of  the  good  already  accomplished."  By  the 
end  of  the  first  year  nearly  one  hundred  applications 
for  admission  to  the  school  had  been  made,  and  we 
had  all  the  pupils  we  were  allowed  to  receive,  though 
a  majority  of  the  young  women  withdrew  their  names 
on  learning  that  hard  work  was  required.  For  it 
came  to  be  slowly  understood  by  outsiders  that  heart 
and  soul  and  mind  and  strength  must  be  put  into 
this  work  if  it  were  to  be  well  done.  There  was  the 
same  lack  of  understanding  during  our  Civil  War,  and 
among  the  enthusiasts  who  wished  to  be  forwarded  to 
the  front  came  a  young  New  York  woman  to  the  nurs- 
ing committee  one  day,  and  stated  her  requirements 
in  taking  up  the  service  for  the  wounded.  They  in- 
cluded a  daily  bath  on  the  battle-field,  and  when  com- 
mon-sense was  talked  to  her,  and  her  services  were 
declined,  she  left  greatly  disturbed,  and  saying  that, 
though  she  could  not  work,  she  thought  she  might  be 
allowed  to  soothe  and  sympathise. 

By  the  end  of  our  second  year  we  were  able  to  send 
out  our  first  graduates  to  private  families.  Six  of 
them  nursed  thirty-seven  cases  with  entire  satisfac- 
tion to  the  patients.  By  the  fourth  year  we  began  to 
furnish  superintendents  of  nursing  to  other  hospitals, 
and  to  nurse  the  poor  free  of  charge  in  New  Haven. 
Fifty  charity  visits  were  made  that  year.  By  the 
sixth  year  we  felt  strong  enough  to  publish  our  own 
hand-book  of  nursing.  By  the  seventh  the  seven- 
teen pupils  had  quite  outgrown  their  quarters  in  the 
mansard  story,  and  Mrs.  Noah  Porter,  the  president 
of  our  board,  appealed  at  our  annual  meeting,  Janu- 
ary, 1 88 1,  for  funds  to  build  a  dormitory.  So  com- 
plete was  the  public  confidence  in  us  that  the  entire 
amount  ($12,000)  needed  for  the  building  was  raised 


432  A  History  of  Nursing 

at  once,  and  Professor  Eaton  and  Dr.  Bacon,  who  had 
been  appointed  by  the  hospital  directors  for  this  ser- 
vice, staked  out  the  site  on  the  hospital  grounds,  and 
by  October  26,  1882,  our  pleasant  building  was  opened, 
Mr.  R.  S.  Fellow  and  Dr.  Shew,  of  the  Middletown 
hospital,  having  selected  for  us  the  furniture  from  a 
factory  in  New  Hampshire  at  a  cost  of  about  $1,000 
more.  We  were  in  clear  water  now,  and  little  remains 
to  tell  you  except  a  story  of  continual  prosperity.   .   .   . 

In  concluding  this  sketch  of  the  early  days  of 
our  first  three  schools  for  nurses  we  cannot  do  bet- 
ter than  quote  from  a  pamphlet  written  by  one 
of  the  Bellevue  Hospital  committee  ^  which  is  full 
of  practical  w^isdom  and  foresight.  After  a  broad 
historical  review  and  study  of  methods  of  institu- 
tional management  it  points  out  the  anachronism 
of  having  the  governing  boards  for  mixed  institu- 
tions composed  entirely  of  men,  and  says: 

The  most  thorough  way  to  secure  oneness  of  organ- 
isation and  purpose  would  be  to  add  to  the  hospital 
board  a  certain  number  of  ladies,  and  to  make  the 
school  of  nursing  committee  one  of  the  regular  sub- 
committees of  the  board.  .  .  .  Hitherto  the  move- 
ment toward  improving  the  nursing  service  of  public 
hospitals  has  come  from  outside  persons  as  a  rule:  it 
has  not  originated  with  the  governing  bodies.  As 
nursing  is  work  which  peculiarly  requires  feminine 
supervision,  the  majority  of  the  members  of  school 
committees  hitherto  have  been  women.  ...  If  hos- 
pital governors  object  to  extraneous  authority  .... 

1  A  Century  of  Cursing,  with  Hints  toward  the  Organisation 
of  a  Training  School.      (The  author  was  Mrs.  Hobson.)     1876. 


A  Trio  of  Training  Schools       433 

why  should  they  not  invite  the  school  committee  to 
become  members  of  their  board  ....  under  their 
own  control  as  are  their  other  committees  ?  .  .  . 

In  the  case  of  a  large  public  hospital,  i.  e.,  a  tax- 
payers' hospital,  the  outside  committee  has  its  advan- 
tages. If  its  members  find  themselves  unreasonably 
obstructed,  they  have  the  remedy  of  the  English 
ministry :  they  can  "  go  to  the  country. " 

A  great  deal  would  depend  upon  the  character  of  the 
hospital  and  its  own  form  of  government.  Any  plan 
of  organisation  is  the  best  which  will  keep  all  discus- 
sion of  questions  of  general  policy  and  of  the  mutual 
relations  that  are  involved  aboveboard  and  open, 
and  that  will  leave  neither  opportunity  nor  necessity 
for  attempt  on  the  part  of  any  one  to  carry  points 
by  indirect  or  personal  influence.  .  .  .  Better  the 
treaties  which  the  Paris  administration  makes  with  its 
Sisterhoods  than  any  effort  to  diplomatise  one's  way 
into  a  hospital  and  shuffle  along  there  without  a  full, 
clear,  written  agreement  on  the  points  in  advance,  so 
far  as  they  can  be  foreseen,  between  the  committee  of 
the  school  and  the  governing  bodies  of  the  hospital.  .  . 

As  the  object  of  the  hospital  is  the  nursing  of  the 
sick,  the  superintendent  of  the  school  becomes  the 
most  important  female  officer.  She  should,  therefore, 
if  possible,  be  the  matron  as  well  as  the  nursing  head 
for  the  whole  hospital ;  in  which  case  she  would  require 
an  assistant  to  whom  she  could  delegate  certain  classes 
of  housekeeping  duties.  .  .  . 

Too  frequent  changes  among  head  nurses  are  unde- 
sirable from  a  disciplinary  point  of  view.  It  would 
be  an  advantage  to  a  school  to  be  able  to  retain  and 
pay  adequately  a  certain  number  of  skilled  trainers 
for  head  nurses  of  wards  or  groups  of  wards.  .  .  , 

VOL.  II. — 28 


434  A  History  of  Nursing 

Committees  would  do  well  to  start  on  the  plan  with 
the  idea  that  careful  didactic  and  technical  instruc- 
tion must  be  a  part  of  their  plan  and  that  they  will 
need  a  school  outfit:  classroom,  blackboard,  text- 
book, and  manikins;  the  cost  of  which  should  be  con- 
sidered an  essential  original  outlay,  and  not  left  to 
any  after  chance. 

American  schools  pay  their  pupils  monthly  wages, 
but  these,  if  paid  at  all,  ought  to  be  moderate.  Schools 
should  not  compete  with  each  other  on  the  basis  of 
numbers  or  high  wages,  but  on  that  of  the  quality  of 
nurses  they  turn  out,  and  the  best  pupils  are  sure  to 
value  instruction  more  if  they  are  not  paid  for  acquir- 
ing it.  Those  schools  will  probably  prove  to  be  the 
most  successful  where  the  pupils  can  be  brought  to 
feel  that  they  are  studying  a  profession,  or  learning  a 
trade,  under  the  ordinary  conditions  imposed  on  men 
and  women  who  are  preparing  themselves  for  any 
business  in  life. 

It  is  a  question  whether  a  nursing  school  should 
class  itself  with  charities.  If  money  appeals  to  the 
public  must  be  made,  why  should  they  not  be  made 
on  the  higher  ground  that  colleges  take? 

Why  should  there  not  be  endowed  tutorships 
and  free  scholarships  for  nurses  in  Belle vue  and 
Baltimore?  .  .   . 

In  concluding  this  brief  sketch  the  writer  urges  all 
women  engaged  in  hospitals  and  training  schools  to 
bear  in  mind  that  their  greatest  success  will  lie  in 
keeping  the  standard  of  their  work,  as  to  the  char- 
acter and  tone  of  the  direction,  and  the  quality  of  the 
instruction  given,  at  its  highest  possible  point.  Schools 
should  be  practically  normal  schools,  whose  graduates 
should  feel  that  wherever  they  go  they  must  carry  the 


A  Trio  of  Training  Schools        435 

spirit  of  the  school  with  them  and  that  training  can  go 
on  in  every  hospital  ward  where  a  competent  head 
nurse  is  found. 

Doubtless  there  will  be  obstacles  to  encounter, 
but  these  should  only  nerve  to  steadier  effort,  for  it  is 
well  to  remember  that  any  obstacle  either  thought- 
lessly or  maliciously  thrust  in  the  way  of  women  of 
culture  who  undertake  offices  of  charity  in  public  insti- 
tutions is  a  blow  direct,  not  so  much  against  them,  as 
against  the  helpless  and  suffering  classes  of  society 
of  whom  they  are  the  natural  guardians  and  consolers. 


BIBLIOGRAPHY. 

The  grouping  according  to  subject  is  to  facilitate  study  or  courses  of 
reading.  Some  of  the  footnote  references  are  repeated  here,  while  others 
are  new.  No  attempt  has  been  made  to  give  a  full  list  of  magazine  articles. 
Many  books  on  nursing,  as  well  as  text-books,  belonging  more  especially  to 
the  last  twenty-five  years,  will  be  listed  in  another  volume. 


GENERAL  NURSING  HISTORY. 

*  Offentliche  Krankenpflege  im  Mittelalter.  Dr.  Victor 
Fossel.  Reprint  from  Mittheilungen  des  Vereines  der  "  Arzte 
in  Steiermark."     Nos.  4  &  5,  1900.     Graz,  Austria. 

The  Historical  Development  of  Modern  Nursing.  A 
Jacobi,  M.D.     Popular  Science  Monthly,  xxiii.,  773-787. 

*  A  Century  of  Nursing.  Reports  of  State  Charities  Aid. 
New  York.      1876. 

Die  Geschichte  Christlicher  Krankenpflege  und  Pflegerschaf- 
ten.     Dr.  Henrich  Haeser,  Berlin,  1857. 

*  Christian  Charity  in  the  Ancient  Church.  Gerhard  Uhl- 
horn,  Stuttgart,  1882. 

Handhuch  der  Krankenversorgung  und  Krankenpflege.  Liebe, 
Jacobsohn  und  Meyer,  Berlin,  1899.  August  Hirschwald. 
In  3  vols. 

*  Considerations  sur  les  Infirmieres  des  Hopitaux,  These 
presentee  et  publiquement  soutenue  d,  la  Faculte  de  Medecine  de 
Montpellier.  Dr  Anna  Hamilton,  Imprimerie  Centrale  du 
Midi,  Montpellier,  1900. 

*  Les  Gardes- Malades  Congrcganistes,  Alercenaires,  Pro- 
fessionnelles,  Amateurs.  Drs.  Anna  Hamilton  and  Felix  Reg- 
nault.     Vigot  Freres,  Paris,  1901. 

*  The  Evolution  of  the  Trained  Nurse.  Ethel  Gordon 
Fenwick.     The  Outlook.     Jan.  6,  1900. 

437 


43^  A  History  of  Nursing 

*  The  History  of  Nursing  in  tlie  British  Empire.  By  Sarah 
Tooley.     Bousfield,  London,  1906. 

*  Recollections  of  a  Nurse.  By  E,  D.  London,  Macmil- 
lan  &  Co.,  1889. 

RELIGIOUS    NURSING   ORDERS. 

*  Sisterhoods  in  tlie  Church  of  Engla>id.  Margaret  Good- 
man.    London,  Smith,  Elder  &  Co.,  1864. 

*  Handbook  to  Christian  and  Ecclesiastical  Rome.  M.  A.  R. 
Tuker  and  Hope  Malleson.  Macmillan.  New  York  and 
London,  1900. 

*  TJie  Military  Religious  Orders  of  the  Middle  Ages.  F.  C. 
Woodhouse,  M.A.     London,  1879. 

*  Deaconesses.     Rev.  J.   S.   Howson.     Longmans,  1862. 

*  Sisters  of  Charity,  CatJtolic  and  Protestant,  at  Home  and 
Abroad.  By  Mrs.  Jameson.  London,  Longmans,  Brown, 
Green  and  Longmans,  1855. 

*  Hospitals  and  Sisterhoods .  Mary  Stanley.  2nd  edition. 
London,  John  Murray,  1855. 

*  Sisterlwods  and  Deaconesses  at  Home  and  Abroad.  Henry 
C.  Potter,  D.D.     New  York,  E.  P.  Button  &  Co.,  1873. 

*  Deaconesses  in  Europe.  Jane  M.  Bancroft,  Ph.D.  New 
York,  Hunt  &  Eaton,  1890. 

*  Deaconesses,  A'ncient  and  Modern.  Rev.  Henry  vVheeler. 
New  York,  Hunt  8c  Eaton,  1889. 

*  The  Deaconess:  Her  Vocation.  Bishop  Thobum.  New 
York,  Hunt  &  Eaton,  1893. 

*  Deaconesses,  Biblical,  Early  Church,  European,  American. 
Lucy  Rider  Meyer.     Cincinnati,  Cranston  &  Stowe,  1889. 

*  Woman's  Work  in  the  Church.  John  Malcolm  Ludlow. 
London,  1865. 

KAISERSWERTH    BIBLIOGRAPHY. 

*  Kaiserswerth  and  the  Protestant  Deaconesses.  By  Miss 
Sewell.     2^Iacmillans  ^Iagazine,]a.nMSLry,  1870. 

Jahresbericlite  fiber  die  Diakonissen  Anstali  zu  Kaiserswerht 
am  Rhein.     Kaiserswerth. 

*  Mutter  Fliedner.  Zum  Geddchtniss.    Kaiserswerth.    1892. 
Pastorin  Friederike  Fliedner;  die  erste  Vorsteherin  der  Dia- 
konissen   Anstalt.        Reprint  from   monthly  magazine  pub- 


Bibliography  439 

lished  at  Kaiserswerth,   called  Armen-und-Kranken-Freund, 
1871. 

An  Account  of  the  Institution  for  Deaconesses.  By  Florence 
Nightingale.     London,  185 1. 

*  Life  of  Pastor  Fliedner.  Trans,  from  the  German  by  per- 
mission of  his  family,  by  Catherine  Winkworth.  London,  186 7. 

*  Das  Diakonissen  Mutterhaus  und  seine  Tochterhduser. 
Dr.  Julius  Disselhoff,  Kaiserswerth.      1893. 

*  Kaiserswerth.  Zur  Erineerung  an  den  Besuch  der  Dia- 
konissen Anstalt  in  Kaiserswerth. 

*  Jubilate.  Denkschrift  zur  Jubelfeier.  Julius  Disselhoff, 
Kaiserswerth,  1886. 

*  Jahrbuch  fiir  Christliche  Unterhaltung.  Kaiserswerth, 
1894.     Lives  of  Friederike  and  Caroline  Fliedner. 

*  Theodor  Fliedner.  Kurzer  Abriss  seines  Lebens  und 
Wirkens.  Georg  Fliedner.     Kaiserswerth,  1886-92. 

Theodor  Fliedner,  der  Begrunder  von  Kaiserswerth.  Fritz 
Fliedner,  1886. 

Gertrud  Reichart.     Armen  und  Kranken  Freund,  1 869. 

Kollektenreise  nach  Holland  und  England.  Th.  Fliedner. 
Essen,  Badeker,  1831. 

Das  Erste  Jahr-Zehnt  der  Diakonissen  Anstalt.  Kaisers- 
werth, 1836-37. 

Kurze  Entstehungsgeschichte  der  ersten  evangel.  Liebesan- 
stalt  zu  Kaiserswerth.  Armen  und  Kranken  Freund,  1856; 
also  separate  leaflet. 

Haus-Ordnung  und  Dienstanweisungen  fiir  die  Diakonissen 
Anstalt  zu  Kaiserswerth.     Th.  Fliedner.     Kaiserswerth,  1845. 

*  Life  of  Agnes  Elizabeth  Jones,  by  her  sister.  (Contains 
much  detail  of  the  life  at  Kaiserswerth,  where  she  spent  a 
year.  Appendix  A  was  first  published  in  the  Dublin  Uni- 
versity Magazine,  April,  1859,  as  an  article  called  "Kaisers- 
werth, the  Training  School  of  Florence  Nightingale." 

*  A  Pilgrimage  to  Kaiserswerth.  L.  L.  Dock  in  Short 
Studies  on  Nursing  Subjects.     New  York,  1 900. 

NIGHTINGALE   BIBLIOGRAPHY. 

Experience  of  a  Civilian  in  Eastern  Military  Hospitals. 
Peter  Pincoffs,  M.D.     Williams  &  Norgate,  London,  1857. 


440  A  History  of  Nursing 

Excellent  account  of  Miss  Nightingale  in  the  chapter  called 
"The  Providence  of  the  Barrack  Hospital." 

The  Seat  of  War  in  tfw  East.  William  Simpson.  Day  & 
Sons,  London,  1902.  Reprinted  from  ed.  of  1855,  A  good 
chapter  on  Miss  Nightingale. 

The  Illustrated  History  of  the  War  with  Russia.  E.  H. 
Nolan,  Ph.D.,  LL.D.  J.  S.  Virtue,  London,  1857.  Excellent 
account  of  Miss  Nightingale  in  chapter  called  "Scutari  and  its 
Hospitals." 

The  Invasion  of  tJie  Crimea.  Kinglake.  1880.  Vol.  6, 
chap.  xi.  An  excellent  and  fascinating  chapter  on  Miss  N. 
and  her  work  called  "The  Care  of  the  Sick  and  the  Wounded." 

*  Scutari  and  its  Hospitals.  Rev.  Sydney  G.  Osborne. 
Dickenson  Bros.,  London,  1855. 

The  Story  of  Fioreyice  Nightingale.  W.  J.Wintle.  Sunday- 
Sdiool  Union,  London.  No  date.  Good  and  detailed  account 
of  her  early  life, 

*  Flvre}u:e  Nightingale.  Eliza  F.  Pollard.  S.  W.  Partridge 
Co.,  London,  1902.  The  most  complete  and  full  as  to 
detail,  quiet  and  authoritative  in  tone. 

Figlits  for  the  Flag.  Contains  life  of  Miss  Nightingale 
called  "The  Lady  with  the  Lamp."  W.  H.  Fitchett.  Geo. 
Bell  &  Sons,  London,  1898. 

*  Great  Men  and  Famous  Women.  Vol.  iii.  Life  of 
Miss  Nightingale,  by  Lizzie  Aldridge.  Selmar  Hess,  New 
York. 

*  Notable  Woynen.  Contains  life  of  Miss  Nightingale. 
Ellen  C.  Clayton.     Dean  &  Son,  London.     No  date. 

*  The  Life  of  Flore)ice  Nightingale.  Sarah  Tooley.  Bous- 
field  Co.,  London,  1906. 

*  Life  of  Sidney  Herbert,  Lord  Herbert  of  Lea.  By  Lord 
Stanmore.  Murray,  London,  1907.  In  2  vols.  Contains 
portions  of  Miss  Nightingale's  letters  not  heretofore 
published. 

MISS  nightingale's  writings. 

1851.  The  Protestant  Deaconesses  of  Kaiserswerth.  A 
pamphlet  describing  the  Kaiserswerth  institutions  and  train- 
ing. A  long  quotation  from  it  in  Appendix,  Note  A,  Hos- 
pitals and  Sisterhoods,  by  Miss  Stanley. 


Bibliography  44 1 

1857.  Statements  Exhibiting  the  Voluntary  Contributions. 
Being  a  report  giving  complete  statistics  and  record  of  all  the 
voluntary  contributions  which  had  passed  through  her  hands 
during  the  war.     Harrison,  St.  Martin's  Lane. 

1857-1860.  An  Exhaustive  and  Confidential  Report  on  the 
Workings  of  the  Army  Medical  Department  in  the  Crimea.  Used 
in  the  reorganisation  of  that  service.     Never  printed. 

*  1858.  Notes  on  Matters  Affecting  the  Health,  Efficiency, 
and  Hospital  Administration  of  the  British  Army. 

*  1859.  Notes  on  Hospitals.  First  presented  to  the  Engl. 
Nat.  Asso.  for  the  promotion  of  Social  Science. 

1859.       Enlarged    and  revised    edition   of    same.     Long- 
mans, Green  &  Co. 

*  i860.  Notes  on  Nursing;  What  it  Is  and  What  it  Is 
Not.     In  many  editions.     D.  Appleton,  New  York. 

*  1 86 1.  Notes  on  Nursing  for  the  Labouring  Classes.  A 
modified  edition  of  Notes  on  Nursing,  with  special  reference 
to  the  care  of  babies,  and  a  new  chapter  addressed  to  the 
older  sisters  (little  mothers). 

1862.  Army  Sanitary  Administration  and  its  Reform  under 
the  late  Lord  Herbert.  Read  at  London  meeting  of  the  Con- 
gres  de  Bienfaisance,  June,  1862. 

1863.  The  Sanitary  State  of  the  Army  in  India.  Observa- 
tions on  the  evidence  contained  in  the  statistical  reports 
submitted  to  her  by  the  Royal  Commission  on  the  same.  Re- 
printed by  order  from  the  report  of  the  Royal  Commission. 
Edw.  Stanford,  6  Charing  Cross,  1863. 

1863.  How  People  may  Live  and  not  Die  in  India.  Read 
at  the  Edinburgh  meeting  of  the  Nat.  Soc.  Sci.  Cong.,  in  1863. 
Reprint  as  pamphlet. 

*  1865,  An  Introduction  to  an  Account  of  the  Origin  and 
Organisation  of  the  Liverpool  School  and  Home  for  Nurses. 

*  1867.  Suggestions  for  the  Improvement  of  the  Nursing 
Service  of  Hospitals  and  on  the  Methods  of  Training  Nurses 
for  the  Sick  Poor.  Written  by  request  of  the  Poor  Law 
Board  after  the  Poor  Act  of  1867;  in  their  reports  and  in 
Blue  Book,  "Metropolitan  Workhouses." 

*  1868.  Una  and  the  Lion.  An  introduction  to  the 
Memorial  of  Agnes  E.  Jones,  by  her  sister.  First  appeared 
in  Good  Words,  ]nne,  1868. 


442  A  History  of  Nursing 

*  187 1.  Lying-in  Hospitals;  with  a  Proposal  for  Organ- 
ising  an  Institute  for  Training  Midwives  and  Midwifery 
Nurses.     Longmans,  Green  &  Co.,  1871. 

1873.  Life  or  Death  in  India.  Read  at  the  Xorcs^ich  meet- 
ing of  the  Nat.  Asso.  for  the  Promotion  of  Soc.  Sci.,  1873. 
Published  as  pamphlet  with  an  appendix  on  irrigation,  called 
"  Life  or  Death  by  Irrigation." 

*  1873.  ''A  Sub-Xote  of  Interrogation."  Fraser's  Maga- 
zine, May,  1873. 

1876.  A  letter  to  the  Times,  April  14.  Reprinted  as  pam- 
phlet called  Trained  Nursing  for  the  Sick  Poor:  a  Home  for 
Nurses  in  connection  with  the  National  Society  for  Providing 
Trained  Nursing  for  tJie  Sick  Poor.  Expresses  her  views  on 
district  nursing. 

1 89 1.  Article  on  Hospitals  and  Nursing,  Chambers's  Ei:- 
cyclopedia. 

*  1892.  The  Reform  of  Sick-Nursings  and  tlie  Late  Mrs. 
Wardroper,  Brit.  Med.  Journal,  Dec.  31. 

*  1893.  Rural  Hygiene:  Health  Teachings  in  Towns  and 
Villages.  Read  at  the  Conference  of  Women  Workers, 
Leeds,  November,  1893. 

*  1893.  Sick-Nursing  and  Health-Nursing.  Written  for 
and  read  at  the  Nursing  Section  of  the  Congress  of  Charities 
and  Correction  in  Chicago,  World's  Fair,  1893. 

1894.  Village  Sanitation  in  India.  Read  before  the  Trop- 
ical Section,  8th  Internat.  Cong.  Hygiene  and  Demography, 
Budapest,  September,  1894. 

1894.  Two  articles  in  Quain's  Dictionary  of  Medicine. 
"Nurses:  Training  of,"  "  Nursing  the  Sick."  1894.  In 
later  editions  of  Ouain  these  articles  have  been  entirely 
garbled  by  a  medical  editor  and  their  individuality  is  quite 
lost. 

GENERAL  BIOGRAPHY. 

Amalie  Sieveking.  In  German — Denkwtlrdigkeiten  aus  dem 
Leben  von.  M.  E.  Vorwort  von  Dr.  Wichem.  Hamburg, 
i860.  In  French — Memoires  authentiques,  etc.  Paris  and 
Geneva,  i860. 

*  Mutter  Fliedner.  Zum  Gedachtniss.     Kaiserswerth.    1892. 
Life  and  Works  of  Deaconess  Harriet  Monsel.     Rev.  T.  T. 

Carter.     London. 


Bibliography  443 

Makrina,  das  Hochgehild  einer  Christlicher  Jungfrau.  Ham- 
burg.    Ag.  des  Rauhen  Hauses,  1864. 

*  "Friederike  Fliedner,  the  First  Superintendent  of  the 
Deaconess  Institution  at  Kaiserswerth."  The  British  Jour- 
nal of  Nursing,  May  26,  1906,  et  seq.  Trans,  by  L.  Metta 
Saunders. 

*  The  same  in  German,  in  Kaiserswerth  Bibliography. 

*  Memorials  of  Agnes  Elizabeth  Jones,  by  her  sister. 
James  Nisbet&Co.,  London,  1885.     (12th  edition.) 

*  Sister  Dora.  By  Margaret  Lonsdale.  Boston,  Roberts 
Bros.,  1880.     From  the  6th  EngHsh  edition. 

Olympia.  An  account  of  in  Die  Alte  Kirche:  part  9,  das 
vierte  Jahrhundert.  By  Friedrich  and  Paul  Bohringer.  Con- 
tents, Johannes  Chrysostomus  und  Olympias.  Stuttgart, 
1876.     Published  by  Meyer  &  Zeller. 

Fabiola  and  the  Roman  Matrons.  An  account  of  in  St.  Je- 
rome; la  Societe  Chretienne  a  Rome  et  V emigration  romaine 
en  Terre  Sainte.     Thierry  (Amedee),  Paris,  1867. 

*  On  similar  lines.  The  Makers  of  Modern  Rome,  by  Mrs. 
Oliphant,  New  York  and  London,  Book  I;  Honourable 
Women  not  a  Few,  Macmillan  Co.,  1896. 

Histoire  de  Sainte  Hildegarde.  Le  R.  P.  Jacques  Renard. 
Paris.     1865. 

*  Histoire  de  Mile.  Le  Gras  {Louise  de  Alarillac).  By  the 
Countess  de  Richemont.  4th  ed.  Paris,  Ch.  Poussielgue, 
1894. 

*  La  vie  de  Mademoiselle  Le  Gras.  By  Monsieur  Gobillon 
Paris.     1676. 

*  Vie  de  Mademoiselle  Mance  and  History  of  the  Hotel  Dieti 
of  Ville  Marie  (Montreal).  Published  by  the  Sisters  of  the 
Hotel  Dieu  de  Ville  Marie.     1854.     In  2  vols. 

*  Memoirs  of  Edward  and  Catherine  Stanley  (containing  a 
biographical  notice  of  Mary  Stanley).  Edited  by  Arthur 
Penrhyn  Stanley,  D.D.  3d  edition.  John  Murray,  London. 
1880. 

*  Life  of  Dorothea  Lynde  Dix.  By  Francis  Tiffany.  Bos- 
ton and  New  York,  Houghton,  Mifflin  &  Co.,  1892. 

EARLY    TEXT-BOOKS    ON    NURSING 

Von  der  Wartung  der  Kranken.      Unzer,  1769. 


444  A  History  of  Nursing 

Unterrickt  fur  Krankenwdrter.  Franz  May,  Mannheim, 
1784. 

Manuel  pour  les  gardes  malades.     Carrere,  Strassburg,  1787. 

Unterrickt  filr  Personen  welche  Kranken  warten.  J.  G. 
Pfahler.     Riga,  1793. 

Die  Kunst  der  Kranken  zu  pflegen.  Anselm  Martin,  Mun- 
chen,  1832. 

Anleitung  zur  Krankenwartung.     Dieffenbach,  Berlin,  1832. 

*  The  Domestic  Management  of  the  Sick-Room.  Anthony 
Todd  Thomson,  M.D.,  F.L.S.  ist  American  from  2nd  Eng- 
Hsh  ed.     London,  Lee  Bros.,  1845.      ist  EngHsh  ed.  1841. 

*  The  Nurse's  Guide.  By  J.  Warrington,  M.D.  Philadel- 
phia, Thomas,  Cowperthwaite  &  Co.,  1839. 

*  The  Young  Mother's  Guide  and  Nurse's  Manual.  By 
Richards.  Kissam,  M.D.     2nded.     Hartford,  1837. 

*  Friendly  Cautions  to  the  Heads  of  Families,  etc.,  with  Am- 
ple Directions  to  Nurses  who  Attend  the  Sick.  3d  ed.  By 
Robert  Wallace  Johnson,  M.D.  ist  American  ed.  Phila- 
delphia, 1804. 

*  The  Good  Nurse;  or  hints  on  the  management  of  the  Sick 
and  Lying-in  Chamber  and  the  Nursery.  No  author  named. 
London,  1825.     Dedicated  to  Miss  Priscilla  Wakefield. 

*  The  Good  Samaritan,  or  Complete  English  Physician.  By 
Dr.  Lobb,  member  of  the  Royal  College  of  Physicians  in  Lon- 
don, and  other  ejP-inent  Practitioners.     London.     No  date. 

*  The  Practice  of  the  British  and  French  Hospitals.  A 
Select  Body  of  useful  and  elegant  Medicines  for  the  several  dis- 
orders incident  to  the  Human  Body,  etc.     London,  1773. 

*  The  Science  and  Art  of  Nursing  the  Sick.  By  .^neas 
Munro,  M.D.     Glasgow,  James  Maclehose,  1873. 

*  Accidents:  Popular  Directions  for  their  Immediate  Treat- 
ment. By  Henry  Wheaton  Rivers,  M.D.  Boston,  Thomas 
H.  Webb  &  Co.,  1845. 

*  The  Nurse.  No  author  given.  London,  Houlston  and 
Stoneman.     No  date.      (About  1830?) 

*  An  Essay  upon  Nursing  and  the  Management  of  Children. 
By  W.  Cadogan,  late  physician  to  the  Foundling  Hospital. 
9th  ed.     London,  1769. 

*  Hints  for  the  Nursery,  or  the  Young  Mother's  Guide.  By 
Mrs.  C.  A.  Hopkinson..     Boston,  Little,  Brown  &  Co.,  1863. 


Bibliography  445 

*  First  Helps  in  Accidents  and  in  Sickness.  Published  with 
the  recommendation  of  the  Highest  Medical  Authority.  Bos- 
ton, Alexander  Moore;  New  York,  Lee,  Shepard  &  Dilling- 
ham.    1871. 

*  Till  the  Doctor  Comes.  By  George  H.  Hope,  M.D.  New 
York,  G.  P.  Putnam's  Sons,  187 1. 

*  Handbook  for  Hospital  Sisters.  By  Florence  S.  Lees. 
Isbister  &  Co.,  London,  1874. 

*  Bellevue  Manual,  1887.  Called  "A  Manual  of  Nursing." 
Compiled  from  suggestions  of  Dr.  Emily  Blackwell,  and  mate- 
rial from  a  manual  by  Miss  Zepherina  Veitch  and  Domville, 
M.D.  Also  much  from  Miss  Nightingale  and  Florence  Lees. 
Compiled  by  Victoria  White,  revised  by  Dr.  Mary  Putnam 
Jacobi.     G.  P.  Putnam's  Sons,  New  York. 

Connecticut  Manual,  New  Haven.      1878. 
Charity  Hospital  Manual.     New  York.     By  Dr.  Frankel, 
1878. 

UNITED  STATES GENERAL  OUTLINES    OF    HISTORY 

*  "Miss  Linda  Richards."  By  one  of  her  Pupils.  Ameri- 
can Journal  of  Nursing,  October,  1900,  p.  12  et  seq. 

*  "How  Trained  Nursing  began  in  America.  By  Linda 
Richards.  American  Journal  of  Nursing.  November,  1901, 
p.  88. 

*  "The  Reform  in  Nursing  in  Bellevue  Hospital."  By  L. 
L.  Dock.  American  Journal  of  Nursing,  November,  1901, 
p.  89  et  seq. 

*  "Early  History  of  the  Boston  Training  School."  By 
Miss  Curtis  and  Miss  Denny.  American  Journal  of  Nursing, 
February,  1902,  p.  331  ^^  seq. 

*  "  Recollections  of  a  Pioneer  Nurse."  By  Linda  Richards. 
American  Journal  of  Nursing,  January,  1903,  p.  245,  et  seq. 

*  "A  New  Profession  for  Women."  Century  Magazine, 
July,  1882. 

*  "History  of  the  Establishment  of  Bellevue."  By  the 
Managers.  Read  at  the  Waldorf-Astoria,  March  6,  1899,  on 
the  25th  anniversary  of  the  School. 

*  Reports  of  the  New  York  State  Charities  Aid  Association: 
Report  of  Committee  on  Hospitals,  No.  i,  1872.  Report  of 
Special  Committee  in  regard  to  building  New  Bellevue,  No.  4. 


446  A  History  of  Nursing 

"Training  Schools  for  Nurses."  By  Chas.  P.  Putnam, 
Boston.     Penn  Monthly,  December,  1874. 

*  An  Account  of  Bellevue  Hospital.  Robert  Carlisle,  M.D. 
New  York,  1893. 

Appendix  to  tlie  Life  of  Elizabeth  Agnes  Jones.  By  her  sis- 
ter. From  the  second  London  edition.  (Contains  in  appen- 
dix an  account  of  American  nursing.) 

*  "The  Organisation  of  Training  Schools  in  America." 
By  Louise  Darche.     Chicago  World's  Fair  Papers,  p.  5 18. 

For  the  convenience  of  students,  material  that  may  be  found  in  the  re- 
ference horary  of  the  Johns  Hopkins  Training  School  for  Nurses  has  been 
marked  with  an  asterisk.  The  greater  part  of  the  footnote  references  is 
also  to  be  found  there. 

MISCELLANEOUS 
(Found  only  in  French  libraries) 

Histoire  de  Saint  Cesaire,  by  the  abbe  J.  M.  Trichaud, 
Aries,  1853.     Contains  rules  of  the  nuns  of  Aries. 

Uancien  Hdpital  d'Auhrac,  by  the  abbe  Bousquet,  Mont- 
pellier,  1841. 

Histoire  de  Saint  Radego}ide,  by  the  abbe  Briand,  Poitiers; 
also  a  large  edition  illustrated. 

UHotel-Dieu  de  Beaii-ne,  144 5-1880,  by  the  abbe  E.  Bavard, 
Beaune,  1881.     Illustrated. 

La  vie  de  Mile,  de  Meleim  (Melun),  by  George  and  Louis 
Josse,  Paris,  16S7. 

Histoire  de  Sainte  CJtantal,  by  the  abbe  Bougaud,  Paris, 
1863. 

Les  ScBurs  Hospitalih'es,  by  Dr.  Armand  Despres,  Paris, 
1886. 


INDEX 


Abelard's  instructions  to 
Heloise,  i,  156 

Air  cushions  and  rings,  in- 
vention of,  i,  255 

Alexandria,  early  hospital 
work  at,  i,  120-12 1 

American  Medical  Associa- 
tion, report  of  Committee 
on  Training  of  Nurses,  ii, 
366-369 

Ancient  Rome,  charities  of, 
i,  90-91;  good- will  of  gods 
in  cure  of  disease,  i,  84; 
organised  medical  service, 
i,  87-89 

Angers,  organisation  and 
training  of  Sisters  at,  i, 
426-427 

Animals,  habits  in  illness,  i, 
9-1 1 ;  mutual  aid  instinct, 
i,  1-6 

Anne  of  Austria  as  a  nurse,  i, 

349 

Appliances,  hospital  and  nurs- 
ing, i,  233-256 

Arabians  and  hospital  work, 
i,  246-249 

Army  medical  service,  origin 
of,  ii,  3^3, 

Association  of  Charity,  es- 
tablishment of,  i,  407 

Assyrians  and  BalDylonians, 
disease  theory  of,  i,  58; 
medical  records  of,  i,  56; 
regulations  for  the  practice 
of  surgery,  i,  56-57 


Athelstane,  founder  of  first 
hospital  in  England,  i,  450 

Augustinian  Sisters  at  Hotel- 
Dieu,  Paris,  i,  294-334; 
in  Canada,  i,  369-383;  in 
England,  i,  448-457;  origin 
of,  i,  294 


B 


Babylonians  and  Assyrians, 

disease    theory    of,    i,    58; 

medical   records  of,   i,    56; 

regulations  for  the  practice 

of  surgery,  i,  56-57 
Barber-surgeons,  origin  of,  i, 

477 

Basil,  bishop  of  Cesarea,  work 
of,  i,  123-125 

Basilias,  establishment  of,  i, 
123 

Bath-tubs,  need  of,  urged  by 
Dr.  John  Gregorie,  i,  470 

Beaune,  description  of  hos- 
pital at,  i,  269-270 

Beds,  canopied,  objection  to, 
i.  253,255 

— iron,  introduction  of,  1,  242 ; 
objections  to,  i,  255 

— jointed,  first  use  of,  i,  253 

— wooden,  in  use  during 
eighteenth  century,  i,  251 

Bed-screens,  portable,  in- 
vention of,  i,  253 

Bedsores,  early  treatment  of, 
i,  253  _ 

Bed-warmers,  early  use  of,  1, 
252, 255 


447 


448 


Index 


B^guines  as  nurses,  i,  264, 
268 ;  changes  among,  i,  271; 
description  of  settlement 
at  Flanders,  i,  262  ;founders 
of  Sisters  of  St.  Martha, 
of  Burgundy,  i,  270-271; 
freedom  described,  i,  268; 
in  charge  of  hospital  at 
Beaune;  i,  269;  life  of,  i, 
263;  opposition  to,  i,  267; 
origin  of,  i,  260-261;  re- 
semblance to  Tertiaries  of 
St.  Francis  and  St.  Domi- 
nic, i,  266 

Bellevue  Hospital,  early  con- 
ditions, ii,  328-330;  epi- 
demic of  puerperal  fever, 
ii,  404;  establishment  and 
opening  of  training  school, 
ii.  383-387,  394;  investiga- 
tions   and    improvements, 

ii.  33^-33^'  376-383.  402- 
409;  origin,  ii,  326-328; 
principles  of  training  school 
ii,  398-400;  uniforms  adopt- 
ed for  nurses,  ii,  401 ;  work 
of  first  superintendent,  ii, 
394-396 

Benedictines,  medical  skill 
of,  i,  154 

Bertheau,  Caroline.  See  Flied- 
ner,  Caroline 

Bibliography  of  literature  of 
nursing,  ii,  437-446 

Biscot,  Jeanne,     work  of,   i, 

350 
Blackwell,      Dr.      Elizabeth, 
work  of,    during  the  Civil 


War, 


11,  358-359,  361-362 


Bleeding  and  cupping,  prac- 
tice of,  by  savages,  i,  24 

Blockley  Hospital,  early  con- 
ditions, ii,  332-335;  origin, 

ii.  33^ 
Bon  Secours,  origin  of.  i,  289 
Bouquet,  Genevieve,  reformer 
of  nursing  at  Hotel-Dieu, 
Paris,  i,  32  1-324 
Bowden,  Miss,  letter  to  Train- 
ing    School     at     Bellevue 
Hospital,   ii,  411;  work  at 


Bellevue  Hospital,  ii,  394- 
396 

Bracelli,  Virginia,  founder  of 
Daughters  of  Our  Lady  of 
Mount  Calvary,  i,  339 

Brignole,  Emanuele,  reform- 
er of  Daughters  of  Our 
Lady  of  Mount  Calvary,  i, 

339 
Brothers  of  Mercy,   descrip- 
tion of  order,  i,  342;  duties 
of,  i,  340;    founding  of,    i, 
341 


Camillus,  founder  of  Clerks 
Regular  and  Camellines,  i, 
338 

Catherine  of  Genoa  as  a  nurse, 
i,  348 

Celli,  Angelo,  investigation  of 
Italian  hospitals  by,  i,  513 

Cesaria  and  Cesarius,  work  of, 
i,  158 

Ceylon,  hospitals  and  chari- 
ties of,  i,  43-45 

Chalon  -  sur  -  Saone,  descrip- 
tion of  hospital  at,  i,  270 

Charities  Aid  Association 
of  New  York  State,  de- 
partments of,  ii,  371;  in- 
vestigations of  Bellevue 
Hospital  by,  ii,  376-383; 
organisation  of,  ii,  371; 
work  of  Hospitals  Com- 
mittee, 372-388 

Children's  epidemics,  Flor- 
ence Nightingale  on,  ii,  215 

Christian  nursing,  beginning 
of.  i,  100 

Ciudad,  Jean,  founder  of 
Fate-bene-Fratelli,  i,  337 

Civil  War,  organisation  of 
Sanitary  Commission,  ii, 
358;  work  of  Dorothea 
Lynde  Dix,  ii,  363-365; 
work  of  Dr.  Elizabeth 
Blackwell,  ii,  358-359.  361- 
362  ;  work  of  Louisa  Schuy- 
ler, ii,  358-360 


i 


Index 


449 


Clerks  Regular.  Ministers  of 
the  Infirm,  founding  of,  i. 

Clothing  of  bed  patients  in 
early  hospitals,  i,  255 

Connecticut  Training  School, 
foundation  of,  ii,  424-432 

Contagion  in  crowded  wards, 
i,  250 

Correspondence  with  early- 
English  hospitals  regard- 
ing spiritual  care  of  pa- 
tients, i,  509 

"Cottage  Nursing,"  attempt 
at,  i,  468 

Cow's  milk,  first  use  of,  for 
infants,  i,  243 

Craven,  Mrs.  Dacre,  work  of, 
ii,  298-300 

Crimean  War,  conditions  at 
Scutari  hospital,  ii,  121- 
124,  138-141;  demand  for 
nurses,  ii,  114-116;  ex- 
tracts from  the  writings 
of  a  Lady  Volunteer,  ii, 
134-135.  137-141 ;  Florence 
Nightingale  on  conditions 
of  the  British  Army,  ii,  224- 
23 1 ;  hardships  of  nurses 
at  Scutari,  ii,  140-141; 
lack  of  medical  care,  ii,  114- 
115;  work  of  Florence 
Nightingale,  ii,  101-171; 
work  of  nursing  staff,  ii, 
156-161 

Crusade,  nursing  during,  i, 
175-180 

Culpeper,  Nicholas,  extracts 
from  Pharmacopeia  Lon- 
dinensis,  i,  485-487 

D 

Dames  de  Charite,  organisa- 
tion of,  i,  412,  413 

Danish  field  hospitals  in  1758, 
regulations  of,  i,  513 

Dark  period  of  nursing,  i, 
499-524 

Daughters  of  our  Lady  of 
Mount  Calvary,  founding 
of.  i,  339 


Deaconess,  The,  publication 
of,  i,  542 

Deaconess,  title  of,  opposed 
by  Pastor  Gossner,  i,  543 

Deaconesses  {see  also'Kaisers- 
werth)  appointed  by  Mora- 
vians, i,  529;  decline  of 
standards  among,  ii,  47; 
description  of,  by  Wil- 
helm  Lohe,  i,  116;  ear- 
liest work,  i,  101-106;  em- 
ployed by  presbytery,  i, 
527;  first  school  for,  ii,  3; 
founders  of  nurses'  calling, 
i,  115;  growth  of  order,  1, 
103;  in  ancient  Rome,  i, 
133;  in  Germany,  i,  527; 
in  Holland,  i,  528-529; 
opposition  to  intellectual 
life  among,  ii,  48-50;  plea 
for  return  of,  by  Johann 
Klonne,  i,  541;  resemblance 
to  Sisters  of  Charity,  ii, 
35-36;  training  described 
by  Schafer,  ii,  39;  visiting 
nursing  by,  i,  528 

d'Aguillon,  Duchess,  founder 
of  Hotel-Dieu  at  Quebec,  i, 
368 

de  Bouillon,  Godfrey,  work 
of,  i,  177-179 

de  Bresoles,  Judith,  work  of, 
at  Montreal,  i,  395 

de  Chantal,  Mme.,  as  a  visit- 
ing nurse,  i,  351 

de  Goussalt,  Mme.,  work  of, 
i,  412-413 

de  Marillac,  Louise  (Mile,  le 
Gras) ,  appearance  and  char- 
acter, i,  434;  dedication  by 
vow  to  charitable  work,  i, 
420;  early  work,  i,  418; 
first  call  to  hospital  service 
i,  426 

de  Melun,  Mile.,  as  a  nurse, 

i.  349 

Desault,  criticisms  of  hospi- 
tal service  at  Hotel-Dieu, 
Paris,  by,  i,  328 

Diakonias,  or  home  hospitals, 
establishment  of ,  i,  118 


450 


Index 


Dieffenbach,  Z.  F.,  nursing 
manual  by,  i,  538 

Discipline  of  nurses,  Florence 
Nightingale  on,   ii,    264 

Disease  as  an  evil  spirit,  be- 
lief in,  i,  14,  15-16,  17-18, 
42,  58;  as  punishment  for 
sin,  i,  58;  witches  and 
sorcery  in,  i,  14,  16-21,  45 

Disinfectants,  early,  i,  251- 
252 

Disinfection  as  recommended 
by  Dieffenbach,  i,  539 

District  nursing  (see  also 
Visiting  nursing),  estab- 
lishment of,  at  Kaisers- 
werth,  ii,  30;  first  example 
of,  i,  102;  improvement  in, 
ii,  298 

Dix,  Dorothea  Lynde,  work 
of,  ii,  363-365 

Dunant,  Henri,  originator  of 
Red  Cross  Society,  ii,  314- 
315 


E 


Early  Christians  and  hospital 
work,  i,  95-143 

Early  English  nursing,  i,  441- 
476 

Egyptians,  hygienic  rules  of, 
i'  52-53;  medical  records 
of,  i,  47-49;  nursing,  medi- 
cine and  surgery  of,  i,  47- 
55;  sanitan,^  laws  of,  52-53 

Elizabeth  of  Hungary^  work 
of,  i,  218-223 

Elizabeth,  Queen  of  Portugal, 
in  hospital  work,  i,  348 

English  (early)  nursing,  i, 
441-476 

English  system  of  nursing, 
gradual  changes  in,  ii,  304- 

English  training  schools,  ser- 
vant-nurse in,  ii,  184-185 
Epidauros,  ancient  cure  at,  i, 

^  71-74 

Epidemics  at  Quebec,  i,  360- 

3^3^  371 


Extracts  from  Ambroise  Pa- 
rk's diary,  i,  480-485;  from 
FlorenceXightingale's  writ- 
ings, ii,  208-223,  224-237, 
241-259,  260-286;  from 
John  Howard's  Lazarettos 
and  Hospitals,  i,  506-508; 
from  Nicholas  Culpeper's 
Pharmacopeia  Londinensis , 
i,  485-487;  from  The  Good 
Samaritan,  i,  490-497 


Fabiola,  description  of,  by 
Jerome,  i,  138;  hospital  and 
nursing  work  of,  i,  137 

Fate-bene-Fratelli,  founding 
of  order,  i,  337 ;  growth  and 
work,  i,  337-338 

First  hospital  in  England,  i, 

450 

Fliedner,  Caroline,  character 
of,  ii,  26 

Fliedner,  Friederike,  as  super- 
intendent at  Kaiserswerth, 
ii,  16-18,  19-21;  at  Dussel- 
dorf,  ii,  8;  first  woman 
writer  on  the  training  of 
nurses,  ii,  18;  first  work  at 
Kaiserswerth,  ii,  9;  organi- 
sation of  nursing  work 
outside  of  Kaiserswerth, 
ii,  21 

Fliedner,  Theodor,  advocate 
of  women  teachers  in  pub- 
lic schools,  ii,  34;  estab- 
lishment of  refuge  for  pris- 
oners by,  ii,  10;  founding 
of  Rhenish-Westphalian 
Prison  Association,  ii,  6; 
journey  to  Holland  and 
England,  ii,  5;  resemblance 
to  Vincent  de  Paul,  ii,  35; 
visit  to  America,  ii,  31 

Flower  Mission,  establish- 
ment of,  ii,  293 

Foundling  hospitals.  See 
Hospitals,  foundling 

Frances,  Duchess  of  Brittany, 
as  a  nurse,  i,  349 


Index 


451 


French  hospitals  in  America, 
i,  355-402 

Friendly  visiting  established 
by  Amalie  Sieveking,  i, 
546-548;  Florence  Nightin- 
gale on,  ii,  237 

Friends,  Society  of.  See 
Quakers 

Fry,  Elizabeth,  influence  of 
Kaiserswerth  upon  work 
of,  ii,  72;  visit  of  Theodor 
Fliedner,  ii,  6;  visit  to 
Kaiserswerth,  ii,  19;  work 
of,  ii,  70-76 


Gabriele,  story  of,  ii,  50-60 

Geneva  Treaty,  adoption  of, 
ii,  316 

GObel,  Katherine,  at  Kaisers- 
werth, ii,  10 

Gooch,  Dr.,  on  the  training 
of  nurses,  ii,  65-66 

Good  Samaritan,  extracts 
from,  i,  490-497 

Gossner,  Johannes,  work  of, 

i.  543 

Greece  and  early  medicine,  i, 
67-82;  early  examples  of 
hospital  work,  i,  70-72; 
early  medical  schools,  i, 
75;  teachings  of  Aretaeus, 
i,  79-82;  teachings  of  Hip- 
pocrates, i,  76-77 

Greek  physicians,  teachings 
of,  i,  76-77,  79-82 

Gregorie,  Dr.  John,  on  need 
of  bath-tubs  in  hospitals, 
i,  470 


H 


Health  and  nursing  the  well, 

Florence    Nightingale    on, 

ii,  269-271 

Heloise,  nursing  under,  i,  157 

Hildegarde,  work  of,  i,  162- 

170 


Hindoos,  early  examples  of 
municipal  hospitals  among, 
i,  3  3 ;  extracts  from  writings 
of,  i,  32-39;  hygienic  rules 
of,  i,  31;  inoculation  for 
small-pox  among,  i,  38-39; 
medical  writings  of,  i,  29, 
37;  rules  for  nurses  and 
physicians,  i,  32;  rules  re- 
lating to  surgical  opera- 
tions, i,  36-37 

Hippocrates,  teachings  of,  i, 
76-77 

Home  life  for  nurses,  Florence 
Nightingale     on,    ii,    272- 

273 

Hospital  and  nursing  appli- 
ances, i,  233-256 

Hospital  construction,  im- 
provement in,  i,  254;  ob- 
literated by  scientific  work, 

i.  255 
Hospital    management,    ab- 
sence of  women  in,  i,  499- 
506;  criticisms  of,  by  John 
Howard,  i,   471-476,   517- 
524;  criticisms  of,  by  Will- 
iam Nolan,  i,  504 
Hospital  training  for  nurses 
at  Elizabeth  Hospital,  Ber- 
lin, i,  543 
Hospitals : 

Alexandrian,  i,  129 
Alsace,  i,  161 
Arabian,  i,  246-249 
Aries,  i,  158 
Canada : 

H6tel-Dieu,  Montreal,  i, 

383-388,  391 
H6tel-Dieu,     Quebec,    i, 

355-368,  381 
St.  Catherine's   General 
and  Marine  Hospital, 

ii.  354-355 
Constantinople : 

Hospital     of     St.     John 

Chrysostom,  i,  127 
Jewish  Hospital,  i,  523 
England : 

Hospital  of  Herbaldown, 
i,  451 


452 


Index 


Hospitals  (Continued): 

Hospital  of  St.  Giles  in 
the  East,  i,  451 

Hospital  of  St.  John  the 
Baptist,  i,  451 

Hospital  of  St.  Kathar- 
ine, i,  452 

Hospital  of  St.  Peter  and 
St.  Leonard  at  York,  i, 
450 

Middlesex  Hospital,  i, 
471-476 

Norfolk  and  Norwich 
Hospital,  i,  476 

St.  Bartholomew's  Hos- 
pital, i,  452,  455-457. 
461-465;  ii,  304-311 

St.  Bartholomew's  Hos- 
pital for     Lepers,      i, 

451 
St.  Thomas's  Hospital,  i, 

462,  463,  464,  d.66-467 ; 

ii,  181 
France : 

Hopital  des  Petites  Mai- 
sons,  i,  522 
Hospital    at    Beaune,    i, 

269-270 
Hospital  at  Chalon-sur- 

Saone  i,  270 
Hospital    of    St.    John, 

Brussels,  i,  520 
Hospital  of  St.  Louis,  i, 

522 
Hospital   of    the    Salpe- 

triere,  Paris,  i,  521 
Hotel-Dieu,     Lyons,      i, 

281-292 
Hotel-Dieu,  Paris,  i,  292- 

335 

La  Comtesse  Hospital, 
Lille,  i,  521 

St.     Sauveur    Hospital, 
Lille,  i,  521 
Germany: 

Charite  Hospital,  Berlin, 
ii,   26-28 

Elizabeth  Hospital,  Ber- 
lin, i,  543 

Hospital  at  Neumarkt 
for  lepers,  i,  226 


Hospital  of  Maria  Mag- 

dalena,  i,  223 
Hospital  of  St.  Barbara, 

i,  249 
St.    Peter's   Hospital   in 

Prague,  i,  226 
Ireland : 

Maryborough  Infirmary, 

i.  523 
Italy : 

Hospital  of  the  Ben  Fra- 
telli,  Naples,  i.  519 

Hospital  of  St.  Esprit  at 
Dijon,  i,  238 

Hospital  of  Santa  Maria 
Annunziata,  i,  245 

Ospedale  Civile,  Venice, 
i,  241 

Ospedale  Maggiore  of 
Milan,  i,  241 

Santa  Maria  Nuova,  Flo- 
rence, i,  241 

Santo   Spirito  in  Rome, 
i,  234,  235-238 
Jerusalem : 

Holy  Infirmary  of 
Knights  of  St.  John, 
i,  195-205 

Hospital  of  St.  John  the 
Almoner,  174-175, 
179,  183-185 

Hospital     of    St.    Mary 
Magdalene,  i,  174 
United  States: 

Bellevue  Hospital,  ii, 
326-331,376-387,394- 
396,  398-409 

Massachusetts,  General 
Hospital  ii,  412-421 

New  England  Hospital 
for  women  and  chil- 
dren, ii,  346-353 

New  York  Hospital,  ii, 
338-339 

Pennsylvania  Hospital  ii, 
335-338 

Woman's  Hospital,  Phil- 
adelphia, ii,  346 
Hospitals     a     part     of     the 
Church,    i,    123,    155,    157, 
158 


Index 


453 


Hospitals  built   by    Fabiola, 

i-  137 
Hospitals  built  by   Paula,  i, 

140 
Hospitals,     early,     and     the 

Roman  matrons,  i,i  18-143 
Hospitals,  foundling: 

Orphan  House  established 
by  Emperor  Alexius,  i,  127 

Ospedala  Santa  Maria  degli 
Innocenti.  i,  242-243 

Santa  Maria  della  Scala,   i, 

243-245 

Hospitals,  historic,  architec- 
ture of ,  i,  238-240,  241-243 

H6tel-Dieu,  Lyons,  found- 
ing of,  i,  281 ;  medical  serv- 
ice, i,  282;  nursing  service, 
i,  283-292 

Hdtel-Dieu,  Montreal,  de- 
scription of,  i,  391;  found- 
ing, i,  388;  origin,  i,  383- 
388 

Hotel-Dieu,  Paris,  early  con- 
ditions, i,  329-333 ;  enlarge- 
ments of,  i,  293;  founding, 
i,  292;  hospital  service 
criticised,  i,  328;  improved 
conditions,  i,  334;  influence 
of  Genevieve  Bouquet,  i, 
321-324;  investigation  by 
civil  authorities,  i,  310; 
lepers  excluded,  i,  293, 
nursing  service,  i,  295-334; 
overcrowding  of,  i,  304, 
328;  visits  of  Dames  de 
Charite,  i,  323 

H6tel-Dieu,  Quebec,  found- 
ing of,  i,  368;  growth,  i, 
381,  origin,  i,  355-3^7 

Hot  water  jugs,  use  of,  i,  252 

Howard,  John,  criticisms  of 
hospital  management  by, 
i,  203-205,  471.  476,  517- 
524;  extracts  from  Lazaret- 
tos and  Hospitals,  i,  506- 
508 

Hygiene  of  ancient  Hindoos, 
i.  30-35;  of  early  Egyp- 
tians, i,  52-53;  of  Jews, 
i,  61-66 


India  {see  also  Hindoos), 
nursing,  medicine,  and  sur- 
gery of,  i,  26-41 

Inoculation  in  small-pox, 
practice  of,  by  ancient 
Hindoos,  i,  30,  38-39;  by 
savages,  i,  24-25 

Institute  of  Nursing,  at  Dev- 
onshire, establishment  of, 
ii.  73 

Isabel  of  Castile  as  a  nurse,  i, 
348 

Italian  hospitals,  architect- 
ure of,  i,  238-240;  inves- 
tigation of,  by  Angelo 
Celli,  i,  513;  worksof  artin, 
i,  236,  238,  241 


J 


Jamme,  Anna  C,  Extract 
from  The  First  Training 
School  in  America,  by,   ii, 

353 
Jesuits  at  Quebec,  i,  355-367 
Jews,   charities  of,   i,   64-65; 

hygienic  laws  of,   i,  61-64 
Jones,  Agnes  Elizabeth,  work 

of,  296-298 


Kaiserswerth  and  the  deacon- 
ess movement,  ii,  1-6 1; 
division  of  work,  ii,  16; 
early  reports  of  work,  ii, 
29-31;  establishment  of 
district  nursing,  ii,  30;  in- 
fluence upon  modern  train- 
ing schools,  ii,  40;  opening 
of  hospital,  ii,  13;  original 
institution,  ii,  10;  prepara- 
tory instruction  of  nurses, 
ii,  30-31,  40-41;  principles 
of  the  Fliedners,  ii,  31-32; 
refuge  for  prisoners,  ii,  10; 
routine  life  of  nurses,  ii, 
41-44;  treatment  of  pa- 
tients, ii,  34 


454 


Index 


Kaiserswerth       Deaconesses' 

Institution,  formal  charter 
granted,  ii,  35 
Kaiserswerth    General    Con- 
ference   of    Motherhouses, 

ii,  35 

King's  College  Hospital,  dif- 
ficulties with  St.  John's 
House,  ii,  93-94;  nursing 
undertaken  by  St.  John's 
House,  ii.,  90-91 

Klonne,  Johann,  impracti- 
cability of  views  on  train- 
ing of  nurses,  i,  541;  pam- 
phlet by,  i,  540 

Kn'ights  of  St.  John,  division 
of,  i,  184;  establishment 
of  Order  in  England,  i, 
205;  female  branch,  i,  180; 
hospital  service  at  Valetta, 
i,  196-205;  origin,  i,  175; 
rules,  i,  186;  work  during 
Crusade,  i,  194-195 

Knights  of  St.  John,  Holy 
Infirmary  of,  criticisms  by 
John  Howard,  i,  203-205; 
description,  i,  196;  duties 
of  officers,  i,  197-203; 
origin,  i,  195 

Knights  of  St.  Lazarus,  origin, 
i,  190-192;  work,  i,i92 


Ladies  of  Charity,  directions 
for  work,  i,  408 

"Lady  probationer"  of  the 
English  hospitals,  ii,  206 

Lanfranc,  Archbishop  of  Can- 
terbury, work  of,  i,  451 

le  Begue,  Lambert,  imprison- 
ment of,  i,  265;  work  of,  i, 
261 

Lees,  Florence.  See  Craven, 
Mrs.  Dacre 

le  Gras,  Mile,  S(,e  de  Maril- 
lac,  Louise 

le  Jeune,  Father,  appeal  for 
hospital  at  Quebec,  i,  367 

le  Pailleur,  Sister,  work  of, 
i.  399 


Lepeintre,  Jeanne,  at  Nantes, 

i,  429 

Lepers  excluded  from  Hotel- 
Dieu,  Paris,  i,  293;  hospital 
for,  established  by  Basil, 
i,  123;  St.  Bartholomew's 
Hospital  for,  i,  451;  St. 
Francis  of  Assisi  among,  i, 
210;  work  among,  i,  162 

Lodge,  Thomas,  on  require- 
ments of  a  contagious 
hospital,  i,  454 

Lohe,  Wilhelm,  on  the  work 
of  Deaconesses,  i,  116 


M 


Macrina,  sister  of  Basil,  work 
of,  i,  126 

Mance,  Mile.  Jeanne,  estab- 
lished at  Hotel-Dieu,  Mon- 
treal, i,  391;  founder  of 
Hotel-Dieu,  Montreal,  i,  383 

Mans,  hostility  toward  Sisters 
at,  i,  430 

Marcella,  leader  of  charity 
and  nursing  work,  i,  135 

Maria  Theresa,  Sister,  hon- 
ours presented  to,  i,  440 

Martin,  Anselm,  directions  for 
personal  care  of  patients,  i, 
254 

Massachusetts  General  Hos- 
pital, early  days  of  train- 
ing school,  ii,  416-421; 
establishment  of  training 
school,  ii,  412-415  ;  work  of 
Woman's  Educational  As- 
sociation, ii,  412-414 

Massage,  practice  of,  by 
ancient  Hindoos,  i,  30;  by 
ancient  Romans,  i,  88; 
by  savages,  i,  22 

Mattresses,  hair,  first  use  of, 
i,  253 

May,  Franz,  establishment 
of  course  of  instruction  for 
hospital  attendants,  i,  536; 
on  nurses  and  nursing,  i, 
535-537;  opposition  to 
work  of,  i,  537 


Index 


455 


Meals,   serving   of,    in   early- 
hospitals,  i,  255 
Mediaeval   nursing  orders,    i, 

336-354 

Mediaeval  surgery  and  med- 
ical treatment,   i,  447-498 

Medical  books,  early,  i,  488- 
490 

Medicine,  instruction  in,  in 
connection  with  monaste- 
ries, i,  152;  practice  of,  by 
ancient  Romans,  i,  83-92; 
practice  of,  by  ancient 
Greeks,  i,  67-82;  practice 
of,  by  early  Egyptians,  i, 
47-55;  practice  of,  by 
monastic  orders,  i,  153 

Medicine-man,  development 
of,  i,  14-15,  20-21 

Men  as  nurses,  i,  loi 

Mexico,  old  Spanish  hospitals 
in,  i,  402 

Middlesex  Hospital,  England, 
economies  of,  i,  474;  ex- 
tracts from  minutes,  i,475- 
476;  regulations,  i,  473-474 

Monasticism,  first  example 
of,  i,  136;  rise  of,  144-170; 
rules  governing,  i,  144 

Monastic  orders  and  the 
practice  of  medicine,  i,  153 

More,  Hannah,  influence  of 
life  on  development  of 
reforms,  i,  531 

"  Mother  of  the  Poor  "  (Mme. 
de    Lamoignon),    i.    409 

Mothers  as  nurses,  Florence 
Nightingale  on,  ii,  216-263 

Municipal  control  of  English 
hospitals,  i,  460-461 

Munster,  Friederike,  See 
Fliedner,  Friederike 

N 

Nantes,  installation  of  Sisters 

at,  i,  429 
Napoleonic  war,  influence  on 

nursing  reform,  i,  540 
National     Nursing     Associa 

tion.  England,  organisation 

of,  ii,  299-300 


Nazeau,  Marguerite,  one  of 
the  first  Sisters  of  Charity, 
i,  421 

Neale,  Rev.  Dr.,  founder  of 
St.  Margaret's  Sisterhood, 
ii,  96 

New  England  Hospital  for 
Women  and  Children,  be- 
ginning of  nursing  work,  ii, 
346-349;  establishment  of 
training  school,  ii,  349; 
extract  from  account  of,  ii, 
353;  extracts  from  early 
reports,  ii,  348-351;  re- 
quirements for  admission 
to  training  school,  ii,  350 

New  York  Hospital,  estab- 
lishment of,  ii,  338;  estab- 
lishment of  training  school, 

ii.  339 
Nightingale,  Florence,  at 
Kaiserswerth,  ii,  29,  31, 
112;  at  Scutari,  ii,  120-143  ; 
comments  on,  from  King- 
lake,  ii,  131-133;  co-work- 
ers of  ii,  287-311 ;  descrip- 
tions of,  ii,  1 2  7-1 3 1 ;  educa- 
tion of,  ii,  105  ;extractsfrom 
writings  of,  ii,  208-223, 
224-237,  241-259,  260- 
286,  388-393;  memorial  of, 
Mrs.  Wardroper  by,  ii, 
190-194;  note  on,  from 
Julia  Ward  Howe's  Rem- 
iniscences, ii,  no;  note  on, 
from  Caroline  Fox's  Mem- 
oirs, ii,  105-106;  on  "chil- 
dren's epidemics,"  ii,  215; 
on  -conditions  of  the  British 
Army,  ii,  224-231;  on 
dangers  in  the  nursing  pro- 
fession, ii,  272-277;  on 
discipline  of  nurses,  ii,  264; 
on  essentials  of  a  good 
training  school,  ii,  265-267; 
on  essentials  of  health,  ii, 
213-214;  on  friendly  visit- 
ing, ii,  237;  on  future  of 
nursing,  ii,  278-280;  on 
health  and  nursing  the 
well,  ii,  269-271;  on  home 


45^ 


Index 


Nightingale,  Florence  (Cont.)  : 
life  for  nurses,  ii,  272-273; 
on  lack  of  consideration  for 
nurses,  i,  516;  on  mothers 
as  nurses,  ii,  261-263;  on 
nursing  as  a  "calling,"  ii, 
272;  on  observation  in 
nurses,  ii,  219-221;  on 
position  of  nursing  super- 
intendent, ii,  250-252;  on 
proper  teaching  of  ob- 
stetrics, ii,  239;  on  proper 
ventilation,  ii,  21 1-2 12; 
on  quiet  in  the  sick  room, 
ii,  216;  on  reading  aloud 
in  the  sick  room,  ii,  218; 
on  requisites  of  the  nurse, 
ii,  257-259,  275;  on  sanita- 
tion in  India,  ii,  232-237; 
on  systems  of  nursing  ex- 
isting in  1862,  ii,  241-249; 
on  theory  in  nurses'  train- 
ing, ii,  2  7 4-2  7  5  ;  on  training 
of  nurses,  ii,  263-267,  274- 
280;  on  training  of  proba- 
tioners, ii,  252-253;  on 
unity  among  nurses,  ii, 
277-278;  visit  of  Sidney 
Herbert  to,  ii,  113;  work  of, 
during  the  Crimean  War, 
loi— i7i;writingsof,  ii,  207, 
286 

Nightingale  Home  and  Train- 
ing School,  i,  462 

Nightingale  School  for  nurses, 
brief  principles  of,  ii,  192; 
class  distinction  in,  ii,  199- 
206 ;  compensation  to  pupil 
nurses,  ii,  199;  general  plan 
of,  ii,  182;  influence  of,  on 
nursing  reform,  ii,  183-186, 
206;  length  of  course,  ii, 
-198-199;  obstetrical  train- 
ing established,  ii,  238; 
opening  of,  ii,  181;  opposi- 
tion to,  ii,  1 7 6-1 81;  plans 
for  establishment  of,  ii, 
172-176;  theoretical  teach- 
ing, ii,  200-201;  training 
described  by  Dr.  Gill  Wy- 
lie,  ii,  202-203 


Nolan,  William,  criticisms  of 
hospital    management,     i, 

504 

Nurse  Society  of  Philadel- 
phia, instruction  of  pupils, 
ii,  343;  organisation  of,  ii, 
341-342;  work  of,  ii,  342 

Nursing,  absence  of,  during 
early  epidemics,  i,  453; 
among  savage  tribes,  i, 
21-25;  as  a  "calling," 
Florence  Nightingale  on, 
ii,  272;  as  a  penance  for 
sins,  i,  134;  by  primitive 
man,  i,  12-25;  by  private 
individuals,  i,  135,  137,  141, 
467;  by  religious  orders 
(see  Nursing  orders);  by 
royalty,  i,  157-159,  348- 
349;  by  saints,  i,  210-232; 
combined  with  duties  of 
soldier,  i,  183-185;  decline 
of  standards  of,  i,  499-506; 
development  of,  in  Amer- 
ica, ii,  326-369;  during  the 
Christian  period,  i,  100; 
during  the  Crusades,  i,  178; 
durmg  the  pre-Christian 
period  i,  1-92 ;  early  Eng- 
lish, i,  441-476;  earliest 
examples  of,  by  early  Chris- 
tians, i,  120;  in  America, 
development  of,  ii,  326- 
369;  in  ancient  Greece,  i, 
81-82;  in  ancient  Rome,  i, 
88;  in  Ceylon,  i,  44-45; 
in  India,  i,  32-33;  in  work- 
house infirmaries,  ii,  294; 
instruction  in,  in  connec- 
tion with  monasteries,  i, 
152;  neglect  of,  i,  460 

Nursing  orders: 

Augustinian  Sisters,  i,  294— 

334,  369-383.  448,  457 
Beguines,  Order  of,  i,  259- 

273 
Brignoline  or  Daughters  of 
our  Lady  of  Mt.  Calvary, 

i.  339 
Brothers  of  Mercy,  i,  340- 
342 


Index 


457 


Nursing  orders  iContinued)  : 
Camellines,  or  Daughters  of 

St.  Camillus,  i,  338-339 
Fate-bene-Fratelli,     Order 

of,  i,  337-33^ 
Filles  de  la  Sagesse,  i,  344 
Franciscans,  Order  of,  i,  210 
Grey  Sisters,    Order  of,   i, 

336,  344-345 
Hermandad    del    Refugio, 

Society  of,  i,  343 
Knights  of  St.  John,  i,  175, 

179-187,  194-209 
Knights  of  St.  Lazarus,  i, 

190-194 
St.    Joseph   de    la    Fleche, 

Order  of,  i,  394 
St.  Vincent  de  Paul,  Order 

of,  i,  345.  422-426,  429- 

43i»  439 
Santa  Maria  Nuova,  i,  278 
Santo     Spirito,     or     Holy 

Ghost,  i,  274-276 
Sisterhood  of  All  Saints,  ii, 

95-96 
Sisterhood  of  the  Common 

Life,  i,  273 
Sisterhood  of  the  Poor  Clar- 

isses,  i,  214-216 
Sisterhood  of  St.  Margaret, 

ii,  96-99 
Sisters  of  the  Presentation 

of  the  Holy  Virgin,  i,  344 
Sisters   of   St.    Charles    de 

Nancy,  i,  343 
Sisters    of    St.    Martha    of 

Burgundy,  i,  271 
Third  Order  of  St.  Francis, 

i,  217-218,  339 
Teutonic  Knights, 1,189-190 
Visitation  of  Mary,  Order 

of,  i,  352 
Nursing  orders,  later  medi- 
aeval, i,  336-354;  military, 
i,  171-209 
Nursing  prof  ession ,  dangers  in , 
Florence  Nightingale  on, 
ii,  272-277;  future  of,  Flor- 
ence Nightingale  on,  ii,  278 
-280;  unity  in,  Florence 
Nightingale  on,  ii,  277-278 


Nursing  reform,  influence  of 
Napoleonic  war  on,  i,  540; 
influence  of  Nightingale 
School  on,  ii,  183-186,  206; 
medical  profession  in,  ii, 
366;  opposition  to,   i,    537 

Nursing  Sisters  at  Devon- 
shire, training  of.  ii,  73 

Nursing  systems  existing  in 
1862,  Florence  Nightin- 
gale on,  ii,  241-249 


Observation  in  nurses  urged 
by  Florence  Nightingale,  ii, 
219-221 

Orders  of  early  women  work- 
ers, i,  100 

Organised  charity,  founding 
of,  i,  410 

Orleans,  inefficient  care  of 
sick  at,  i,  415 

Osborne,  Rev.  Sydney,  ac- 
count of  hospital  con- 
ditions at  Scutari,  ii,  121- 
125;  description  of  Flor- 
ence Nightingale,  ii,  127- 
128 


Pare,  Ambroise,  extracts  from 
diary  of,  i,  480-485 

Parry,  Sir  Edward,  Kaisers- 
werth  plan  attempted  by, 
ii,  68-69 

Paula  as  a  nurse,  i,  141 

Pennsylvania  Hospital,  dif- 
ficulty with  women  mana- 
gers, ii,  337-338;  estab- 
lishment of,  ii,  335-336; 
establishment  of  training 
school,  ii,  338 

Persians,  early  hospitals  and 
charities  of,  i,  45-46 

Pf abler,  J.  G.,  on  nurses, 
work,  i,  535 

Phebe,  the  first  deaconess, 
work  of,  i,  101-102 


458 


Index 


Pilgrimages,     early,      i,     97, 

171-173 

Plague  epidemics,  absence  of 
nursing  during,  i,  453 

Pre-Christian  period  of  nurs- 
ing, i,  1-92 

Pre-Fliedner  movements  of 
philanthropy  and  nursing, 
i»  525-549 

Pre-Nightingale  times,  ii,  62- 
100 

Preparatory  instruction  of 
nurses  at  Kaiserswerth,  ii, 
30,  31,  40-41 

Primitive  man  and  the  care 
of  the  sick,  i,  12-25 

Prisoners,  refuge  for,  estab- 
lished at  Kaiserswerth,  ii, 
10 

Pusey,  Dr.,  interest  of,  in 
nursing  reform,  ii,  75,  76 


Q 


Quakers,  influence  of,  upon 
reforms,  i,  531 ;  work  ot,  in 
Philadelphia,  ii,  74,  336, 
338,  340;  work  of  Eliza- 
beth Fry,  ii,  6,  19,  70-76; 
work  of  William  Rathbone, 
ii,  294-295 

Quiet  in  the  sick-room, 
Florence    Nightingale    on, 


11,  216 


Radegunde,  work  of,  i,  159 
Rahere,  founder  of  St.  Bar- 
tholomew's Hospital,  i,  452, 

455 

Rathbone,  William,  work  of, 
ii,  294-295 

Reading  aloud  in  the  sick- 
room, Florence  Nightingale 
on,  ii,  218 

Red  Cross  Knights,  or  Temp- 
lars, origin  and  purpose, 
i,  187-188 


Red  Cross  Society,  origin  of, 
ii,  314-316;  principles  of, 
ii,  317-319;  work  of,  ii, 
320-325 

Red  Cross  work,  earliest  ex- 
amples of,  ii,  312-313 

Reform  in  nursing,  influence 
of  Napoleonic  war  on,  i, 
540;  influence  of  Nightin- 
gale School  on,  ii,  183-186, 
206;  medical  profession  in, 
ii,  366;  opposition  to,  i,  537 

Reichardt,  Gertrude,  first 
Kaiserswerth  deaconess,  ii, 
14 

Religious  nursing,  expulsion 
of,  i,  460 

Reminiscence  of  one  of  the 
first  probationers  at  St. 
Bartholomew's  Hospital, 
ii,  304-311 

Rhenish-Westphalian  Prison 
Association,  founding  of, 
ii,  6 

Richards,  Linda,  work  of,  ii, 
351,  419-423 

Roman  matrons  and  early 
hospitals,  i,  1 18-143 

Royalty,  nursing  by,  i,  157- 

159.348-349 
Rules  governing  St.  Vincent 
de  Paul's  Sisters  of  Charity, 
i,  422-425,  431 


St.  Bartholomew's  Hospital, 
early  days  of,  i,  457-460; 
municipal  control,  i,  461; 
officers,  i,  461;  origin,  i, 
452,  455 ;  physicians'  duties 
i,  465;  reminiscence  of  a 
probationer,  ii,  304-311 

St.  Catherine,  work  of,  i,  229- 
232 

St.  Catherine's  General  and 
Marine  Hospital,  one  of 
the    pioneer    hospitals,    ii, 

354-355 
St.  Ephrem  and  early  hospi- 
tal work,  i,  120 


Index 


459 


St.  Francis  of  Assisi,  work  of, 
i,  211-214 

St.  John  Chrysostom,  hos- 
pital at  Constantinople 
founded  by,  i,  127 

St.  John  the  Almoner,  Hospi- 
tal of,  origin  of ,  i,  174-175; 
rule  regarding  reception 
of  patients,  i,  184 

St.  John's  House,  London, 
connection  with  Charing 
Cross  Hospital,  ii,  94;  con- 
nection with  King's  College 
Hospital,  ii,  90-91;  diffi- 
culties with  King's  College, 
ii,  93-94;  founding  of,  ii, 
80;  organisation  of,  ii,  82; 
and  the  Crimean  War,  ii, 
86-89 

St.  Thomas's  Hospital,  duties 
of  matron,  i,  463 ;  duties 
of  nurses,  i,  464,  466-467; 
duties  of  the  Sister,  i,  466; 
Nightingale  School  for 
nurses  established,  ii,  181; 
origin,  i,  462 

St.  Vincent  de  Paul,  charac- 
ter of,  i,  405;  division  of 
poor  by,  i,  410;  first  or- 
ganised charity  by,  i,  406; 
opposition  of,  to  monastic 
vows  among  Sisters,  i,  422 ; 
rescue  and  relief  of  galley- 
slaves  by,  i,  411;  rules  to 
Sisters,  i,  422 ;  work  for  the 
welfare  of  children,  i,  436 

St.  Vincent  de  Paul,  Order  of, 
at  Angers,  i,  426;  at  Mans, 
i,  430;  at  Nantes,  i,  429; 
first  vows  of  Sisters,  i,  430; 
growth  and  activity  of,  i, 
437;  introduction  of,  into 
United  States,  i,  439;  pre- 
sent activity  in  Rome,  i, 
345;  rules  of,   i,   422-425, 

431 
San  Bernardino,  work,  i,  244 
Sanitary    Commission,    crea- 
tion of,  at  the  opening  of 
the  Civil  War,  ii,  360;  work 
of,  ii,  362-363 


Sanitation  in  India,  Florence 
Nightingale  on,  ii.  232-237; 
of  early  hospitals,   i,   249- 

253 

Saracens,  hospitals  of,  i,  246 

Sarrazin,  naturalist  and  phy- 
sician, i,  392 

Savages,  nursing  among,  i, 
21-25 

Schuyler,  Louisa,  work  of, 
ii,  358-360,  371 

Scurvy,  treatment  by  In- 
dians, i,  362 

Scutari  hospital,  conditions 
during  the  Crimean  War, 
ii,  121-124,  138-141 

Secular  orders,  rise  of,  i,  257- 
280 

Servant-nurses      at      Hotel- 
Dieu,  Lyons,  i,  283-284;  at 
Hotel-Dieu,    Paris,  i,    328 
in  England,  i,  502-503 

Sieveking,  Amalie,  establish- 
ment of  friendly  visiting 
by,  i,  546-548;  first  nursing 
work  of,  i,  545 

Sisterhoods.  See  Nursing 
orders 

Sisterhoods,  Protestant,  in 
connection    with    nursing, 

ii.  355-357 

Sisters  of  Charity  {see  also 
Nursing  orders),  at  Angers, 
i,  426;  at  Mans,  i,  430;  at 
Nantes,  i,  429;  first  step 
toward  founding  of,  i,  416; 
nursing  duties  restricted, 
i,  438;  opposition  to,  i, 
429;  original  home  of,  i,  420 

South,  Dr.  J.  F.,  opposition 
of,  to  the  Nightingale 
school  for  nurses,  ii,  177- 
181 

Soyer,  Alexis,  description  of 
Florence  Nightingale,  ii, 
128-129 

Spanish  hospitals  in  America, 
i,  402-403 

Spiritual  care  of  patients, 
correspondence  with  early 
English  hospitals,  i,  509 


460 


Ind 


ex 


Steamer  chair  and  bed  com- 
bined, first  use  of,  i,  253 

Steevens,  Madam,  founder  of 
oldest  hospital  in  Dublin,  i, 
472 


Teutonic  Knights,  origin  and 
purpose,  i,  189-190 

Theory  in  nurses'  training, 
Florence  Nightingale  on, 
ii,  274-275 

Thermometer,  use  of,  recom- 
mended, i,  252 

Third  Order  of  St.  Francis, 
origin  of,  i,  217-218 

Thouvenin,  Barbe,  head  of 
Sisters  of  St.  Charles  de 
Xancy,  i,  343 

Training  of  nurses  as  recom- 
mended by  Dr.  Gooch,  ii, 
65-69;  first  writings  on,  by 
a  woman,  ii,  18;  Florence 
Nightingale  on,  ii.,  252-257, 
264-267,  271-280 

Training  of  women  for  useful 
lives  urged  by  Sir  Thomas 
More,  ii,  63 

Training  school  for  nurses, 
first  in  America,  ii,  339 

Training  schools,  Florence 
Nightingale  on  the  essen- 
tials of,  ii,  265-267;  mod- 
ern, compared  with  Kai- 
serswerth,  ii,  40;  trio  of,  ii, 

370-435 
Treaty    of    Geneva    and   the 

Red  Cross,  ii,  312-325 
Trio  of  training   schools,    ii, 

370-435 
Tuke,  \\  illiam,  work  of,  i,  470 
Twining,  Louisa,  establish- 
ment of  Flower  Mission 
by,  ii,  293;  work  of,  ii,  287- 
288,  290,  292-293 


U 


Unity  among  nurses,  Florence 
Nightingale  on,  ii,  277-278  i 


Ventilation,  Florence  Night- 
ingale on,  ii.  2 1 1-2 12;  lack 
of,    in    early    hospitals,   i, 

252-253^  53^ 
Virgins,  work  of,  i,  107-113 
Visiting  nursing  by  Mme.  de 
Chantal,  i,  351;  by  saints, 
i,  219,  228;  by  Sisterhood 
of  the  Common  Life,  i,  274; 
by  Sisters  of  St.  Charles  de 
Nancy,    i,    344;    early    ex- 
amples of,  i,  102,  105;  first 
example  of,  i,  102 
Visiting  nursing  order  of  the 
Visitation  of  Mary,  organ- 
isation and  work,   i,  352- 

353 
von  der  Recke  Vollmerstein, 
Count,  work  of,  in  nursing 
reform,  i,  542 

W 

Ward,  Mary,  pioneer  of  re- 
sistance to  enclosed  com- 
munities, i,  353. 

Wardroper,  Mrs.,  matron  of 
St.  Thomas's  Hospital, 
London,  ii,  188-195;  ^^^- 
morial  of,  by  Florence 
Nightingale,  ii,  190-194 

Warrington,  Dr.  Joseph,  work 
of,  ii,  341-345 

Westchester  Poorhouse,  in- 
vestigation    of,     ii,     373- 

375 

Widows,  work  of,  i,  107-113 

Witches  and  sorcery  in  dis- 
ease, i,  14,  16-21,  45 

Woman's  Educational  Asso- 
ciation, work  in  connec- 
tion with  Massachusetts 
General  Hospital,  ii,  412- 
414 

Woman's  Hospital  in  Phila- 
delphia, establishment  of 
training  school,  ii,  346 

Woman's  Society  for  Nursing 
the  Sick,  i,  543 


Index 


461 


Women,  activity  of,  during 
Napoleonic  war,  i,  540; 
as  physicians  and  sur- 
geons during  the  Middle 
Ages,  i,  97;  as  physicians 
and  surgeons  in  fiction,  i, 
347 ;  as  teachers  of  medi- 
cine, i,  162 ;  at  head  of  early 
monastic  nursing,  i,  147- 
150;  in  charitable  and  nurs- 
ing work  in  the  seventeenth 
century,  i,  467;  value  of, 
in  hospital  work  as  shown 
at  Kaiserswerth,  ii,  45; 
work  of,  during  the  Civil 
War,  ii,  358-363;  workers 
of  the  early  church,  i,  95- 
117 

Women's  Central  Relief  Asso- 
ciation, organisation  and 
work  of,  ii,  359-361 


Work  among  fallen  women, 
i,  162 

Workhouse  infirmaries,  intro- 
duction of  nursing  into, 
ii,  294 

Workhouse  reform  by  Agnes 
Jones,  ii,  2  97-298 ;  by  Louisa 
Twining,  ii,  287-288,  290 

Wylie,  Dr.  Gill,  account  of 
visit  to  St.  Thomas's  Hos- 
pital, ii,  202-203;  assist- 
ance of,  in  nursing  reform 
at  Bellevue  Hospital,  ii, 
377 


Xenodochium,  or  home  fof 
strangers,  establishment  of, 
i,  119,  123;  work  and  scope 
of   i,  121-122 


K 


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